Sep 9, 2022 - Health

Superbugs are a "second punch" after pandemic

Illustrated collage of concentric circles, images of bacteria and COVID.

Illustration: Shoshana Gordon/Axios

Superbugs are strengthening their foothold: The COVID-19 pandemic spurred a 15% increase in hospital-related infections and deaths in 2020, per the CDC.

Why it matters: The U.S. was already reporting an antimicrobial resistant (AMR) infection every 11 seconds, and a death from them every 15 minutes before the pandemic. Low- and middle-income countries face worse conditions.

State of play: The COVID pandemic erased years of progress achieved in fighting AMR, the CDC's Michael Craig told the annual World Antimicrobial Resistance Congress this week. He warned the threat of pandemics is not going away, and "the pandemic of [antimicrobial] resistance is not going to go away."

  • The increase in drug-resistant infections seen in 2020 may be partly due to the overprescription of antibiotics to COVID patients and increased use of catheters and ventilators that can lead to infections. Some of the hardest-to-treat infections jumped nearly 80%.
  • But the Biden administration is focused on reversing this problem, as seen in the president's budget, HHS Secretary Xavier Becerra said.
  • It's important to address AMR, Becerra added, because "for many of us it's not so much the first punch. It's the second punch that gets the communities in America. ... The second punch gets those who are least prepared, the most vulnerable, and the most underserved."

By the numbers: Per the CDC, hospitalizations from 2019 to 2020 showed a ...

  • 78% jump in carbapenem-resistant Acinetobacter infections.
  • 32% rise in multidrug-resistant Pseudomonas aeruginosa infections.
  • 14% increase in vancomycin-resistant Enterococcus infections.
  • 13% rise in methicillin-resistant Staphylococcus aureus, or MRSA infections.
  • Overall increase in antifungal-resistant infections, including Candida auris, which increased 60%.
  • Resistant sexually transmitted diseases, like gonorrhea, are a growing threat, per the WHO, which aims to increase reporting of cases to its surveillance program.

Between the lines: There's an urgent need for novel antibiotics, antifungals and preventative vaccines, fast and inexpensive diagnostics, a coordinated surveillance system, a renewed focus on antibiotic stewardship programs and better public awareness communications.

  • Craig points out that developing more vaccines will help prevent infections and deaths as well as lower the risk of AMR because fewer antibiotics will be used overall.
  • Kevin Outterson, co-director of Boston University's health law program and executive director of CARB-X, told Axios "research teams are weighed down by the failure of how we pay for antibiotics."
  • There's been “no new FDA antibiotic approvals since cefiderocol. The out-of-pocket cost of bringing a new compound to FDA approval exceeds $300 million," not counting the cost of failures along the way or the cost of capital to companies investing in this research, Outterson said. Many companies have declared bankruptcy.
  • WHO's Hatim Sati told the conference "fungal pathogens are increasingly becoming a concern" but only 1.5% of all infectious disease research is looking at antifungals and there are only eight candidates in the pipeline.

What we're watching: Calls are growing for Congress to approve the PASTEUR Act to create incentives to develop new antimicrobial drugs, although some say a broader conversation is needed to see if vaccines and antibiotics need to be incentivized differently.

  • The WHO will release its first Fungal Priority Pathogen list on Oct. 4 that it hopes will encourage R&D, Sati said.

Go deeper: Antibiotic pipeline in peril from coronavirus and incentives system

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