Antibiotic resistance is too often labeled a plague for tomorrow. It’s a pressing problem; at least, until a more pressing problem comes along to overshadow it. But experts say we’re already seeing the consequences of prescribing antibiotics to patients who don’t need them.
The overuse of antibiotics is a key factor driving this antibiotic resistance. It has led to the emergence of superbugs, infections that are resistant to frontline antibiotic treatments. And when a bug becomes smart enough to outwit all available antibiotics, what started as a simple infection can overtake the human body and kill.
But in the midst of a pandemic for which there is no cure, doctors who may have thought twice about overprescribing antibiotics are now scrambling to save patients with few treatments at hand.
For patients already seriously ill with COVID-19, the outcome can be devastating. Valerie Vaughn, a hospitalist and assistant professor at the University of Michigan Medical School, saw the unfortunate convergence of COVID-19 and antibiotic resistance firsthand in an intensive care unit earlier in the pandemic.
Antibiotic Resistance Is Here
Vaughn says a patient was given antibiotics upon arriving at the hospital, likely because doctors weren’t sure if he had COVID-19 or a bacterial respiratory infection. He spent several weeks in the hospital on a ventilator after a diagnosis of COVID-19 and his condition worsened. But then, he contracted Clostridium difficile, a serious stomach bug common in hospital patients given antibiotics because it strips them of good bacteria in the gut needed to fight this pathogen. In the end, his C. diff infection was resistant to antibiotic treatments. After a hard-fought battle, he died from multi-organ failure as a result of his C. diff infection.
“That sits with me,” says Vaughn. “Often, when we don’t have a cure, doctors tend to overprescribe. Sometimes you’re doing right by your patient by not doing something.”
But this heartbreaking story is just one example of improper antibiotic use during the pandemic. Vaughn and a team of researchers found that hospitals across Michigan were overprescribing antibiotics to patients that didn’t have bacterial infections. Their study, which is set to appear in Clinical Infectious Diseases, found that between March and June, more than half of COVID-19 patients were prescribed antibiotics when they reached the hospital. However, just 3.5 percent of those patients had a secondary bacterial infection. That means the vast majority of those patients only had COVID-19, a viral infection that doesn’t respond to antibiotics.
One reason for the mix-up is clear. At the time, hospitals often didn’t have enough COVID-19 tests for patients, and turnaround times on results could take days. Frontline medical professionals weren’t sure if patients, arriving in an already precarious state, had COVID-19 or some other serious illness. Often, they relied on symptoms to diagnose and quickly begin treatment. Vaughn’s study found that once COVID-19 tests came back positive, most patients stopped receiving antibiotic treatments altogether.
Another culprit behind antibiotic overprescription is more subtle. On the surface, Vaughn says, COVID-19 pneumonia looks a lot like bacterial pneumonia. But a closer inspection reveals that COVID-19 pneumonia patients have a dry cough with a low white blood cell count. By contrast, bacterial pneumonia patients usually have a productive cough and an elevated white blood cell count. Still, doctors rushing to save a seriously sick patient may get the two pneumonias confused. As the number of COVID-19 patients increases across the nation, busy doctors and hospital staff are again in a rush to save lives.
Some hospitals are handling it better than others, a statistic reflected in Vaughn’s research. She found that the rate of antibiotic use during COVID-19 varied widely and was often linked with the strength of a hospital's antibiotic stewardship program. In places that provided robust support systems, a quarter of COVID-19 patients received antibiotics, while the numbers were closer to 84 percent in hospitals without them. If hospitals have enough COVID-19 tests and a good understanding of bacterial infections, says Vaughn, antibiotic misuse could be tamped down even further.
A Future Without Antibiotics?
Stephen Trent, a professor at the Center for Vaccines and Immunology at the University of Georgia, says he is most concerned with the long-term viability of such overuse.
“Bacteria grow and divide every 20 minutes and the more antibiotics you use the more resistance you end up with,” he says. This is a big problem, Trent says, because we’re running out of antibiotics. Plus, fewer and fewer pharmaceutical companies have both the wherewithal and ambition to develop new treatments.
“I can name five drugs for erectile dysfunction but it seems none of the giant pharmaceutical [companies] are coming up with new antibiotics, a drug without which you can’t do most elective or emergency surgeries,” says Trent. “By 2050, these superbugs will kill more people than cancer.”
He points to the Pasteur Act, named for French immunologist Louis Pasteur and recently introduced by Senators Michael Bennet and Todd Young, as a step in the right direction. The bill would develop a list of prioritized infections for which there is a critical medical need and provide companies with financial incentives to develop the drugs.
As pharmaceutical companies abandon antibiotic research in search of more profitable drugs, says Trent, it’s time for the government to step in and make this a priority. And with a pandemic raging, we’re learning that antibiotic resistance could get worse. COVID-19 isn't going away anytime soon and pumping antibiotics into patients is a big problem in both the long and short term, he says. “We need to do something about it before the well dries up.”