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Antibiotic misuse, poor infection control, and high transmission rates of resistant pathogens fuel antimicrobial resistance and superbugs in hospitals.

Various healthcare organizations define superbugs as microbes, including bacteria, viruses, fungi, and parasites, that have developed resistance to the drugs typically prescribed to eradicate a particular infection.^1-3 A recent report from the CDC indicates that most superbugs are bacterial microbes.⁴

Moreover, research has established that the misuse and overuse of antibiotics in humans, animals, and plants, inadequate infection control measures, and high transmission rates of resistant pathogens in healthcare settings have contributed to the ongoing issue of antimicrobial resistance (AMR) and the development of superbugs.^1-4 While efforts have been implemented to prevent and control AMR, challenges remain, with recently published literature noting that the COVID-19 pandemic added to those challenges.⁴

The CDC indicates that AMR continues to be an urgent global public health issue, and more than 2.8 million AMR infections occur annually in the US, accounting for more than 35,000 mortalities.⁴

A recent CDC report titled Antibiotic Resistance Threats in the United States, 2019 (AR Threats Report) revealed that persistent preventive measures and effective infection control efforts in the US diminished mortality rates from AMR infections by 18% overall and approximately 30% in hospitals.^4,5 The CDC also reports that those efforts declined due to the COVID-19 pandemic, resulting in more resistant infections, increased antibiotic use, and reduced data and prevention actions.^4,5

Additionally, in July 2024, in the CDC’s report Antimicrobial Resistance Threats in the United States 2021-2022, data was presented for seven AMR pathogens that were typically discovered in healthcare settings.⁶ The report also revealed that of the seven AMR pathogens, there were six bacterial antimicrobial-resistant hospital-onset infections, and data shows that these bacterial infections augmented by 20% during the pandemic, climaxing in 2021 and enduring above pre-pandemic levels in 2022.^4,6

The AMR pathogens typically found in healthcare settings include bacteria, such as Carbapenem-resistant Enterobacterales, Carbapenem-resistant Acinetobacter, Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococcus, extended-spectrum beta-lactamase-producing Enterobacterales, multidrug-resistant Pseudomonas aeruginosa, and a drug-resistant yeast, Candida auris (C. auris).^4,6Additionally, clinical cases of C. auris expanded approximately five-fold from 2019 to 2022.^4,6

According to a recent report from the Department of Health and Human Services, the COVID-19 pandemic interrupted several efforts to identify and address the ongoing issue of AMR, noting that it significantly dismantled much of the progress achieved in recent years. The researchers identified numerous factors contributing to these disruptions, such as patient- and facility-level issues, extended hospital stays, and shifts in patient case mix and comorbidities.⁷

Challenges within the healthcare workforce had a critical role, including day-to-day work demands added to burnout due to emotional, psychological, and physical strain. Additionally, there were challenges in adhering to infection prevention and control practices and issues with implementing antimicrobial stewardship programs, particularly during the early stages of the pandemic.

The authors recommended that experts encourage prompt access to AMR data, guidance, and available diagnostics to reduce AMR during public health emergencies. They accentuated the significance of routine, effective multidisciplinary efforts to promote the creation and implementation of effective policies and treatment decisions. Highlighting that knowledge gained from the COVID-19 pandemic can be instrumental in preparing for, implementing, and maintaining proactive antimicrobial stewardship strategies to effectively manage and lessen rates of AMR during future public health emergencies.⁷

In an article in Infection Control & Hospital Epidemiology, researchers conducted a study to approximate the risk for household transmission of MRSA following exposure to infected family members or family members recently discharged from a hospital. Results revealed that exposure to a family member with MRSA in the previous 30 days significantly increased the risk for infection, and this risk also increased with exposure to a recently discharged family member, especially with more extended hospital stays. The authors concluded that recently hospitalized and discharged family members increase the household risk for MRSA infection, even if they weren’t diagnosed with MRSA.⁸

Clinician Perspectives

An internist stated, “Antibiotic resistance continues to be a significant issue, and prescribers should prescribe antibiotics only when necessary. I often encounter patients who are upset if they don’t receive an antibiotic for their infection when it is a viral infection and not a bacterial infection. I explain to them that antibiotics are not effective against viral infections. Fortunately, we have clinical guidelines and protocols for prescribing antibiotics, diagnostic tests to confirm viral infections, and, when needed, culture and sensitivity tests can be ordered to ensure the proper antibiotic is prescribed. Overall, educating patients about the safe and proper use of antimicrobials is essential to promoting responsible use.”

A hospital pharmacist stated, “For years, the misuse, overuse, or unnecessary use of antibiotics has contributed to the ongoing issue of antibiotic resistance. I have encountered patients who end up with recurring infections because they did not complete their course of antibiotic therapy, stopping medication after feeling better, or patients who self-diagnose and use leftover antibiotics. As pharmacists, we can work with prescribers to ensure the appropriate use of antibiotics, participate in antimicrobial stewardship programs to promote the judicious use of antibiotics, and counsel patients about the importance of completing their prescribed courses. Our staff also uses valuable resources from the CDC and the Infectious Diseases Society of America about AMR.”

Combating Antimicrobial Resistance

AMR continues to present various challenges for clinicians and patients, including the limited number of treatments, the enormous health and economic burdens, such as more extended hospital stays, increased rates of morbidity and mortality, and the augmented risk for spreading infections, which makes these infections more difficult to control.

Addressing AMR warrants a multifaceted approach that includes implementing effective guidelines and recommendations, antimicrobial stewardship programs, dedicated efforts to implementing infection control measures, expanded awareness, and advancements in rapid diagnostics to quickly identify AMR and determine the most effective treatments to combat them. The CDC notes that AMR can be controlled via appropriate prescribing and use, rapid response, accurate laboratory detection, effective infection prevention and control, and innovative prevention strategies.⁴