By Shari L. Solomon

Nearly all elements of the United States healthcare industry encountered setbacks during the COVID-19 pandemic, including the ongoing fight against antimicrobial resistance. Antimicrobial resistance has emerged as an urgent global public health threat that has the potential to affect people at any stage of life, as well as the healthcare, veterinary and agriculture industries. 

If antibiotics and antifungals lose their effectiveness, then we lose the ability to treat infections and control these public health threats. A 2021 analysis by the Centers for Disease Control and Prevention (CDC) reported that after years of steady reductions in healthcare-associated infections (HAI), U.S. hospitals saw significantly higher rates for four out of six types of HAIs in 2020, many of which are resistant to antibiotics. Antifungal-resistant threats also rose, with Candida auris (C. auris) increasing 60 percent overall. 

The pandemic resulted in more resistant infections, increased antibiotic use, less data and less prevention actions. During the first year of the pandemic, more than 29,400 people died from antimicrobial-resistant infections commonly associated with healthcare. Of these, nearly 40 percent of people acquired such infections while in the hospital. 

This setback can and must be temporary. If properly resourced, the United States can continue to build resilient public health and healthcare systems to keep the nation safe from antimicrobial resistance. 

Data needed 

There is a lack of data pertaining to antimicrobial resistant infections during the pandemic for several reasons. In some instances, healthcare facilities cut back on services or reduced access to care and testing, and public health resources were forced to shift from tracking antimicrobial resistance to tracking COVID-19 cases. 

Since 2016, the CDC has used the Antimicrobial Resistance Laboratory Network to help detect known and emerging antimicrobial resistance in all states. During the COVID-19 pandemic, identifying and reporting data decreased dramatically due to changes in patient care, supply challenges and the overload on health departments. In 2020, submissions were down almost 21 percent. 

The CDC is missing data for nine of the 18 pathogens listed in its 2019 AR Threats Report. Available data has indicated an alarming increase in resistant infections resulting from hospitalization, growing at least 15 percent from 2019 to 2020. The CDC’s 2019 estimates are still the strongest data to show the U.S. burden of antimicrobial resistance. At least 2.8 million antimicrobial-resistant infections continue to occur in the United States each year, and more than 35,000 people die as a result. 

More resources are needed to continue establishing a resilient public health system that can maintain capacity to respond to antimicrobial resistance while also responding to other threats. Without an infrastructure and supply chains grounded in preparedness, critical antimicrobial resistance data will be delayed again when the next threat emerges. 

We must address gaps identified before the COVID-19 pandemic, including expanding the public health workforce, increasing local access to the best detection tools and technology, enhancing cleaning and disinfection practices and expanding laboratory capacities. 

Impact on prevention and control 

Pandemic-related challenges hindered many infection prevention and control practices, such as routine cleaning and disinfection of equipment, isolation of patients and proper use of personal protective equipment (PPE). This challenge is partly due to hospitals’ treatment of sicker patients who required more frequent and longer use of medical devices, such as catheters and ventilators. Hospitals also experienced PPE supply challenges, staffing shortages and longer patient visits. 

C. auris is just one of 18 antimicrobial-resistant bacteria or fungi that remains a threat in healthcare facilities. C. auris is resistant to all three major antifungal drug classes and was primarily identified in acute care facilities pre-pandemic. C. auris clinical cases significantly increased in 2020 due to staffing and supply shortages, an increased number of sicker patients and changes in infection prevention and control practices, such as re-use or extended use of gowns and gloves. 

The COVID-19 pandemic likely intensified the spread of C. auris and hindered detection of additional cases. The rapid rise in cases is concerning and emphasizes the need for continued surveillance, expanded lab capacity, quicker diagnostic tests and robust infection prevention and control programs 

The threat of antimicrobial-resistant infections not only remains present but has worsened over the past two years. The total national burden of deaths from antimicrobial resistance might be much higher than noted above, but data gaps caused by the pandemic hinder that analysis. 

Additional investment is needed to continue addressing antimicrobial resistance while simultaneously responding to COVID-19 and other health threats. Emphasis on infection control and delegating antimicrobial use will need to be implemented across the healthcare industry to protect people from antimicrobial-resistant infections and their spread. Solid infection control and prevention procedures are the most effective tools for combating antimicrobial resistance, reducing healthcare costs and saving patient lives. 

Shari L. Solomon, Esq., is president and founder of CleanHealth Environmental, LLC. CleanHealth provides infection prevention and industrial hygiene training and consulting services geared toward facility personnel and vendors responsible for infection prevention, cleaning and disinfection, and facility operations and maintenance practices. Solomon has more than 20 years of environmental consulting and federal regulatory experience. An attorney by trade, combined with her experience in the industrial hygiene field with a focus on healthcare, Solomon holds a unique expertise and understanding of liability prevention techniques, offering clients practical and valuable risk management solutions.