facilities . This also means educating the public on how they can stop the spread of germs and practice infection prevention in the communities where they live and work . The CDC reports that as of 2017 , dedicated infection prevention and control efforts in the United States contributed to reduced deaths from antimicrobial-resistant infections by 18 percent overall and by nearly 30 percent in hospitals . However , the pandemic has undone much of this progress . In a 2021 analysis , CDC reported that , after years of steady reductions in healthcare-associated infections ( HAIs ), U . S . hospitals saw significantly higher rates for four out of six types of HAIs in 2020 . Many of these HAIs are resistant to antibiotics or antifungals . Additionally , there were more and sicker patients during the pandemic who required more frequent and longer use of catheters and ventilators . This may have increased risk of HAIs and spread of pathogens , especially when combined with personal protective equipment and lab supply challenges , reduced staff , and longer lengths of stay . The CDC asserts that “ The U . S . has been building a solid foundation for public health preparedness and health systems resilience to address antimicrobial resistance . Before 2020 , CDC highlighted the need for a strong foundation for health departments and healthcare facilities to rapidly identify and contain threats before they can spread . Prior to the pandemic , the U . S . National Strategy for Combating Antibiotic-Resistant Bacteria ( CARB National Action Plan ) set a goal that CDC double its investments in health departments to increase infection control and other prevention efforts . In 2021 , the U . S . government provided temporary funding to health departments through the COVID-19 pandemic that addresses some of these gaps . However , health departments will need sustainable resources to ensure these capacities can continue .”
• Antibiotic / Antifungal Use and Access : Optimizing antibiotic use across all healthcare settings and implementing CDC ’ s Core Elements across healthcare settings . In addition , working to promote optimal antibiotic and antifungal use and tracking for companion animals and agriculture . Antibiotic use varied during the COVID-19 pandemic . The CDC says that while antibiotic use throughout the pandemic varied across healthcare settings , antibiotics were commonly prescribed to patients for COVID-19 — even though antibiotics are not effective against viruses . Antibiotic use significantly dropped in 2020 compared to 2019 due to less use of outpatient health care and less spread of other respiratory illnesses that often lead to antibiotic prescribing . However , in 2021 outpatient antibiotic use rebounded . While antibiotic use was lower overall in 2021 compared with 2019 , in August 2021 , antibiotic use exceeded prescribing in 2019 by 3 percent . From 2020 through December 2021 , most antibiotic prescriptions for adults were for azithromycin and increases in azithromycin prescribing corresponded to peaks in cases of COVID-19 . After an initial peak in azithromycin prescribing in March 2020 , azithromycin use decreased during the pandemic . By August 2021 , there was still more azithromycin prescribing than in August 2019 . Antibiotic use was lower overall as of August 2021 compared to 2019 but increased for some antibiotics like azithromycin and ceftriaxone . Approximately half of hospitalized patients received ceftriaxone , which was commonly prescribed with azithromycin . In nursing homes , antibiotic use spiked alongside surges of COVID-19 cases but remains lower overall . However , azithromycin use was 150 percent higher in April 2020 and 82 percent higher in December 2020 than the same months in 2019 . Azithromycin prescribing remained elevated through October 2020 . In 2021 , antibiotic use overall was , on average , 5 percent lower than 2019 . This decrease might be due to fewer nursing home residents during this time , experts suggest .
The CDC emphasizes that public health professionals must continue educating consumers , healthcare providers , and industry on the value , risks , and best practices of antibiotics and antifungals . These drugs are often a treatment option for emerging infectious diseases , particularly when no other treatment options are available or known . While some of this prescribing can be appropriate when risks for related bacterial or fungal infections are unknown , this antibiotic prescribing can also put patients at risk for side effects and further the pressure for resistance to develop and spread . Healthcare workers can protect patients by ensuring antibiotics and antifungals are only used when they are effective and needed , such as to treat life-threatening conditions caused by fungi or bacteria , like sepsis .
• Environment and Sanitation : Expanding the capacity of the National Wastewater Surveillance System to collect antimicrobial resistance data from wastewater treatment plants and healthcare facilities , studying resistance in community and healthcare wastewater domestically and globally . This also includes expanding global capacities to fight antimicrobial resistance in the environment and monitor antimicrobial resistance across One Health . Community-level wastewater surveillance can help public health professionals detect antimicrobial resistance , including new threats , before they are detected in clinical samples . Wastewater from healthcare facilities could also be a key source of resistant microorganisms , resistant genes , and antibiotic or antifungal residues . Hospital patients can have some of the most resistant infections and are commonly prescribed antibiotics or antifungals . The CDC says monitoring healthcare facility wastewater could provide a non-invasive approach to identifying resistance in a facility and aid in decision making , such as performing screening to identify cases early and implement appropriate interventions to prevent spread . Researchers could look for genes that confer resistance , especially to last-line drugs like carbapenems and colistin , to identify resistance that might be present but not yet detected in the healthcare setting . In September 2020 , CDC established the National Wastewater Surveillance System ( NWSS ) to provide community-level data on COVID-19 infection trends by looking for markers in wastewater that tell scientists when SARS-CoV-2 is present . 18 CDC currently funds 43 public health jurisdictions to support wastewater activities across 37 states , 4 cities , and 2 territories . By May 2022 , NWSS had received data from more than 59,000 wastewater samples from more than 900 sites nationwide .
• Vaccines , Therapeutics , and Diagnostics : Enhancing interagency collaboration to accelerate research for developing new antibiotics , antifungals , and therapeutics . For example , working with the Food and Drug Administration to identify ways to support availability of decolonization products . This also includes supporting the use of vaccines to prevent infections , slow the spread of resistance , and reduce antibiotic use , and building a vaccine data platform to inform the development of new vaccines .