Mar 11, 2021 - Science

COVID antibiotic use raises concern for rising resistance, Pew says

Illustration of a repeating pattern of IV drips with random ones highlighted.

Illustration: Aïda Amer/Axios

Doctors tended to overprescribe antibiotics to COVID-19 patients in hospitals during the early pandemic months, but programs designed to limit overuse are helping, according to an analysis from Pew Charitable Trusts.

Why it matters: Antibiotic resistance is a serious threat globally and in the U.S., with rising deaths due to bacterial infection, dwindling novel drugs to treat them, and huge associated economic costs. Many worry the pandemic will only make the problem worse.

Driving the news: Looking at the first six months of the pandemic, Pew researchers found 52% of COVID-19 patients in 5,838 hospital admissions were given at least one antibiotic, 96% of them within the first 48 hours of admission.

  • But, only about 20% of those admitted were diagnosed with suspected or confirmed bacterial pneumonia and 9% were diagnosed with a community acquired UTI — a discrepancy indicating a concerning use of antibiotics, they said.

The pandemic shunted resources away from hospital programs for infection control and other efforts designed to ensure the right antibiotic is only prescribed for known or suspected bacterial infections, using the correct dosage and timeframe, says David Hyun, project director of Pew's Antibiotic Resistance Project.

  • "That kind of resource diversion can significantly jeopardize not only the progress that's been made up to this point in improving antibiotic use, but during a pandemic and the public health crisis like we're in currently right now, it could create complications within a facility of increased levels of antibiotic-resistant infections," Hyun tells Axios.
  • And there is some anecdotal evidence that hospital-acquired antibiotic resistance may be growing, particularly due to the long hospital stays for many COVID-19 patients, Hyun says. One example is a cluster of 34 cases of carbapenem-resistant Acinetobacter baumannii found in a New Jersey hospital.
  • COVID-19 patients could have a higher risk for multiple resistant pathogens.

However, Pew's analysis also found a significant drop-off in antibiotic prescriptions after the first 48 hours — only 15% of admissions had an antibiotic course prescribed in the first 48 hours of admission and another one ordered after that period, says Rachel Zetts, an officer with the Antibiotic Resistance Project.

  • "That may indicate antibiotic stewardship is currently playing a role in improving prescribing within the COVID-19 population," Zetts says.

The big picture: A lack of novel antibiotics in the pipeline is a constant worry in the medical community. Pew also released two briefs looking at the economic incentives needed to entice new development and how the medical community should think outside the box.

What we're watching: IBM Research published a study Thursday in Nature Biomedical Engineering on a new AI tool they developed to speed up the design of molecules for novel antibiotics and other drugs.

  • Per an IBM Research blog, within 48 days their tool identified, created and experimentally tested 20 AI-generated candidates for new antimicrobial peptides, or protein-building blocks for drugs.
  • Out of those 20, two were found to be potential "new non-toxic antimicrobial peptides (AMPs) with strong broad-spectrum potency," IBM's Aleksandra Mojsilovic and Payel Das wrote.

Go deeper: CDC official: Pandemic "explosion" of antibiotic resistance not seen

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