How the pandemic gave power to superbugs

Antibiotics cannot cure COVID. They don’t help a bit. And yet, new data shows that, during the pandemic, COVID patients were given antibiotics – a lot of antibiotics.

That’s bad because the overuse of antibiotics can breed superbugs that are resistant to medications. The impact of this pandemic overuse has lingered even as the pandemic has faded.

So how did this unfortunate turn of events come to be? A series of new reports and papers shed light.

Globally, about 75% of patients hospitalized with COVID were given antibiotics, despite only 8% having a bacterial coinfection where antibiotics would be medically useful. This comes from new data published in late April that was collected through the World Health Organization’s Global Clinical Platform in 65 countries between January 2020 and March 2023.

“It's sobering to see these data,” says Dr. Helen Boucher, dean of Tufts University School of Medicine in Boston, who studies antimicrobial resistance and was not involved in the study.

WHO says the antibiotics were often used “just in case” they could help. Boucher says there are likely several factors playing into this. First, early in the pandemic, clinicians didn’t know much about COVID and were nervous about secondary bacterial infections which can require antibiotics. And second, the hospital personnel who usually were responsible for making sure that antibiotics are used appropriately were instead busy with new assignments to care for the onslaught of COVID patients.

The data vary around the world.

The region with the lowest antibiotic use during the pandemic – 33% – was the Western Pacific region, which stretches from Australia up to China. The highest use – 83% – was in the Eastern Mediterranean and parts of Africa. The use also changed as the pandemic progressed. Prescriptions dropped between 2020 and 2022 in Europe and the Americas, while they ticked up in Africa.

“In low- and middle-income countries, there was less access to diagnostic tests – significantly less – and there was less access to vaccination early in the pandemic. And so, the only tool that many of these health care givers might have had were antibiotics,” Boucher says. “That's not an excuse. But it might be an explanation.”

A sweeping global toll

Around the world, at least 1.2 million deaths were directly caused by drug-resistant pathogens. A new series of papers published this month in The Lancet show that, each year, 750,000 of these deaths in low- and middle-income countries could be avoided by practices such as improved hand washing, better sanitation and the sterilization of equipment in health-care facilities.

Boucher says antibiotic resistance is also an issue in high-income countries like the U.S. She’s had patients who have died because of antimicrobial-resistant infection. She says she’s had to send hospital patients to hospice care “because we don't have antibiotics to treat their infection,” she says. That was never the case when she started her career 30 years ago.

Antibiotic practices during the pandemic reversed progress that had been made before the pandemic. And new data show the impact can still be seen in the number of infections caused by superbugs in U.S. hospitals.

Between 2012 and 2017, the number of deaths caused by resistant bugs dropped by nearly 30% in hospitals, according to a report from the U.S. Centers for Disease Control and Prevention. But during the pandemic, there was a “significant increase” in infections caused by nasty bugs like carbapenem-resistant Acinetobacter.

Researchers from the National Institutes of Health found that, during the pandemic, hospital-acquired antibiotic-resistant infections jumped 32% when compared with data from just before the pandemic – they leapt from 28 cases out of 10,000 hospitalizations to 38 cases out of 10,000 hospitalizations.

And while that number has dropped, it still hasn’t returned to pre-pandemic levels. The most recent data, from late 2022, suggest levels of antibiotic-resistant superbugs remain elevated in hospitals by more than 12%.

“That’s worrisome,” says Dr. Sameer Kadri, an antibiotic resistance epidemiologist at the NIH and a physician in the intensive care unit there, who worked on the preliminary NIH data which were made public in April. “That tells me that we're not back to our baseline. And I think to consider the status quo as a new normal is a colossal mistake.”

He says it’s not clear what’s leading to the elevated level – perhaps continuing short-staffing in hospitals has hurt infection control – but, he says, one thing is clear: When antibiotic medications don’t work against infections patients suffer.

“The antibiotic resistance problem in the U.S. [and] in the world is one of our greatest health-care challenges today,” he says.

In September of this year, the United Nations General Assembly will convene a high-level meeting on how best to address the issue of antimicrobial resistance – and how to prevent it from getting worse.