The next health threat is here — action is needed on anti-microbial resistance

As an infectious diseases physician caring for patients hospitalized with COVID-19, I have seen how secondary infections that are resistant to antibiotics are impacting those patients and complicating our response to an already extremely complex pandemic.

The simultaneous COVID-19 and antibiotic-resistant bacteria pandemics weaken our ability to prepare for and respond to the next public health threat. A study published in August reviewed 148 hospitals across 17 states from March through September 2020 and found increases across many types of health care-associated infections. Alarmingly, there were 24 percent more cases of hospital-onset multidrug-resistant infections than expected if not for COVID-19, including an additional 30 percent hospital-onset MRSA infections.

The increase in antibiotic-resistant infections should worry us all. These difficult-to-treat infections are associated with a greater risk of death, longer hospital stays and increased health care costs at a time when our health care facilities are overwhelmed. An arsenal of safe and effective antibiotics is a key component of routine medical care and our pandemic preparedness and response. That means we must not only ensure that novel antibiotics are developed, but we must also ensure they are used appropriately to protect them from the development of resistance that will render them obsolete. Unfortunately, we struggle on both fronts.

The antibiotic pipeline is not delivering the novel antibiotics patients need for highly resistant infections.  In fact, most large pharmaceutical companies have turned away from antibiotic research and development, and the smaller firms attempting to innovate are struggling to remain in business.  Antibiotics, which must be used judiciously to preserve their effectiveness and are typically prescribed for a short duration, are not a good return on investment, in strictly financial terms. In fact, antimicrobials are the only class of drug for which use in one person can contribute to drug resistance and decrease the drug’s efficacy in the rest of the population.

Antibiotic overuse and misuse, which contribute to the development of resistance, are also key challenges. Antibiotic stewardship programs — a set of coordinated interventions to optimize antibiotic use, implemented by multidisciplinary teams — are effective at reducing inappropriate antibiotic use and resistance, improving patient outcomes and lowering health care costs. Medicare requires that hospitals and long-term care facilities have antibiotic stewardship programs, but many lack the resources necessary for meaningful impact. COVID-19 has further strained stewardship programs, as many of them had to divert their time to the pandemic response, including overseeing the complex administration of COVID-19 therapeutics.

The U.S. needs to prioritize its response to antibiotic resistance to ensure we are better prepared for future threats. The bipartisan Pioneering Antibiotic Subscriptions to End Upsurging Resistance (PASTEUR) Act is a strong step forward. This bill would fundamentally change the way the federal government pays for the most critically needed new antibiotics — a shift from paying for volume to paying for value. Under PASTEUR, the federal government would partner with novel antibiotic developers and provide set payments for a supply of novel antibiotics, regardless of the number of antibiotics used. This approach would provide the predictable return on investment necessary to ensure we will have the antibiotics we need.

The PASTEUR Act also provides new grants to support antibiotic stewardship programs, prioritizing rural, critical access and safety net hospitals across the country that most need these resources. With this support, hospitals will be better able to provide the robust stewardship services that we know lead to the best outcomes for patients and public health. The new funds can also support hospital reporting of antibiotic use and resistance to the Centers for Disease Control and Prevention (CDC). These data help us understand emerging threats and evaluate our efforts.

As a frontline clinician who has been treating patients since the beginning of the COVID-19 pandemic, I am acutely aware of the frustration in the early days when we did not have effective ways to prevent and treat COVID-19. We do not want to be in the same situation when the next health threat comes knocking at our door.

Antimicrobial resistance isn’t just knocking — it’s already inside the house. But we can do something. The PASTEUR Act is our opportunity to keep antimicrobial resistance from becoming the next public health crisis. Without the PASTEUR Act, we may be facing devastating infections without any tools to fight back.

John B. Lynch, MD, MPH, is an infectious diseases doctor at Harborview Medical Center and professor of medicine at the University of Washington in Seattle.