Available data show an alarming increase in resistant infections starting during hospitalization , growing at least 15 percent from 2019 to 2020 . There are different ways you can parse this data , but I think the impact of the COVID pandemic on antibiotic-resistant bacteria has been extremely significant . ” — Robert Bonomo , MD
specter of new infectious diseases , and changing the balance of Earth has its consequences . What does this have to do with SARS-Co-V2 ? If you look at a paper published in Nature and that came out in January 2020 before we went into lockdown , the authors were saying that climate change increases cross-species viral transmission . They did not know what was going on in China at that time , and so predicted in this paper that species will aggregate new combinations in biodiverse hotspots and in areas of high human population density . The viral world is making its way across the species barrier . Bats will account for the majority of viral sharing and are likely to share viruses along evolutionary pathways that will facilitate future emergence in humans .”
Bonomo continued , “ Not only did we facilitate zoonotic transmission into humans , but could climate change be contributing to making humans even more susceptible to COVID-19 and other resistant bacteria ? A very nice paper was published recently that looked at the compounding effects of climate warming on antibiotic-resistant bacteria and how they respond to elevated temperatures . Bacteria respond to temperature that alters cellular behavior , leading to antibiotic tolerance and persistence . There is a strong link between thermal stress and the evolution and maintenance of antibiotic resistance mutations . Local and global changes in temperature are associated with increases in resistance and its spread . The Centers for Disease Control and Prevention ( CDC ) put out a nice summary of the impact of COVID-19 on antimicrobial resistance , which in my mind is the impact of climate change on COVID-19 and on antimicrobial resistance .”
Bonomo then explored the status of antimicrobial resistance in the era of COVID . “ As we know , AMR is one of the greatest public health threats facing the U . S . More than 3 million Americans acquire either C difficile or some antimicrobial-resistant pathogen . In January 2020 , AMR was the leading cause of death globally , and around this time the CDC identified a significant increase in infectious disease and healthcare-associated pathogens . The leader of the pack is carbapenem resistant Acinetobacter , with ESBL-producing Enterobacteriaceae , VRE and drug-resistant Candida ; resistant hospital-onset infections and deaths increased at least 15 percent within the first year of the pandemic , so there has been a major impact .”
He added , “ Available data show an alarming increase in resistant infections starting during hospitalization , growing at least 15 percent from 2019 to 2020 . There are different ways you can parse this data , but I think the impact of the COVID pandemic on antibiotic-resistant bacteria has been extremely significant . In the first six months of the pandemic , almost 80 percent of patients hospitalized with COVID-19 received an antibiotic , even though their cultures didn ’ t get in the way of that . Approximately half of those patients received ceftriaxone ,
which was commonly prescribed with azithromycin . This likely reflects difficulties in distinguishing COVID-19 from CAP when patients first arrive at a hospital for assessment . We also know that third-generation cephalosporins are known risk factors for ESBLs and MDROs .”
Bonomo said that the early stages of the pandemic accelerated the use of antibiotics , and it also impacted hospital-onset carbapenem resistant Acinetobacter ; cases decreased from 2012 through 2017 , but then they increased 78 percent in 2020 . The increase in 2020 was driven by hospital onset cases , potentially due to longer hospitalizations and secondary bacterial infections , such as pneumonia associated with COVID-19 . In addition to carbapenem resistant Acinetobacter , there were increases in carbapenem-resistant Enterobacteriaceae , Klebsiella , E . coli , CRE , and vancomycin-resistant Enterococcus , multidrug-resistant Pseudomonas aeruginosa , and others . The numbers are going all the wrong way for infection control and stewardship . I think we need to do a better job combatting these foes .”
Bonomo said that the situation can be mitigated , pointing to several studies showing that infection prevention and control practices were able to reduce the number of drug-resistant , hospital-acquired infections , and that the institution of stewardship practices were effective in lowering the rates of acquisition of multidrug-resistant organisms .
“ I asked myself , why is Acinetobacter such a bad actor ? Why are these multidrug-resistant organisms finding their way into the complex healthcare environment ?” he said . “ We ’ re still unclear about the synergy between SARS-Co-V2 and specific bacterial infections . I think that viruses talk to bacteria , bacteria talk to viruses , and together they hate each other and are causing havoc for the host .”
Bonomo continued , “ We have learned that pandemics will happen again , and that climate change may accelerate this threat . We have seen that Acinetobacter is the big beast here , as it is emerging as the most notorious pathogen in many studies ; the global situation may be even worse . I think that viral cross transmission to humans is accelerated by climate change , and that in bacteria , the consequence of increased temperature is increasing resistance . We may not be fully capturing the magnitude of resistance data , as it is still incomplete , not well organized , and fragmented . Our culture methods are insensitive , and the inflammatory milieu of the lung may ‘ hide ’ bacteria , making detection of resistant pathogens even harder to find . And we know that infectious diseases are among the strongest selective pressures driving human existence on the planet . So , what will we ultimately learn from COVID ? It ’ s probably some beast that we haven ’ t really thought about and that I hope that we are ready to face and when we see it , we ’ re ready to face that challenge .”