Researchers are urging the federal government to do more to address the disproportionate health impact of drug-resistant bacteria on older Americans.
Infections caused by pathogens resistant to multiple antibiotics led to more than 11,800 deaths and more than 400,000 inpatient days among adults 65 and older in 2017, according to a new study published Thursday in the journal Clinical Infectious Diseases.
Healthcare costs associated with treating antimicrobial-resistant infections reached $1.9 billion in 2017, with the bulk of expenses and deaths occurring as a result of community-onset infections rather than hospitals.
The findings highlight how antimicrobial resistance poses an increased risk to seniors. Many older individuals have chronic diseases, compromised immune systems, and have more frequent visits to a hospital, all of which can make them more prone to develop infections.
More than a third of deaths and more than a third of healthcare costs from antibiotic-resistant infections came from patients 65 and older, said study co-author Dr. David Hyun, director of the Antibiotic Resistance Project at the Pew Charitable Trust.
"That is indeed a very disproportionate burden that this age group in carrying," Hyun said. "These findings add another layer of urgency to addressing antibiotic resistance issues."
Estimates of deaths and costs related to antibiotic resistant infections were based on a retrospective cohort analysis of nearly 88,000 patients 65 and older admitted to the U.S. Department of Veterans Affairs healthcare system between January 2007 and December 2018.
The study examined the impact of infections caused by the six most common drug-resistant pathogens, which included methicillin-resistant Staphylococcus aureus, or MRSA. A recent Centers for Disease Control and Prevention analysis found cases of several hospital-acquired infections including MRSA were on the rise as a result of the pandemic following years of steady decline.
Hyun said many hospitals may have allowed stewardship and infection prevention protocols to slip during the pandemic as a result of a need to divert resources and staff to address the current crisis.
A Pew analysis released last March found 52% of hospitalized COVID-19 patients during the first six months of the pandemic received at least one antibiotic, while 36% got multiple antibiotics during their stay.
"There's a strong possibility that those findings are linked to the resource depletion that a lot of the hospital antibiotic stewardship and infection control programs have been facing during the COVID-19 pandemic," Hyun said. "We need to take these lessons and try to address them in a way that makes these programs crisis proof."
A paper accompanying the study that was co-authored by Pew and the Infectious Diseases Society of America called for federal action to address the threat of antibiotic-resistance. The CDC estimates more than 2.8 million antibiotic-resistant infections occur in the U.S. every year that result in more than 35,000 deaths.
Among the actions the paper's authors called for were for regulators to establish new rules to crack down on antibiotic overprescribing within outpatient health sites like urgent care centers. A 2018 analysis published in JAMA Internal Medicine found while 40% of outpatient antibiotic prescriptions in 2014 were administered through urgent care centers, 46% of urgent care patients were given antibiotics for conditions that did not require one.
The two groups also advocated for Congress to pass the proposed Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act, which would provide financial incentives for pharmaceutical companies to develop new antibiotics, adding to the therapies available.