Epidemiologist Dr. Sara Cosgrove typically spends her days working on antibiotic stewardship at Johns Hopkins Hospital in Baltimore, monitoring the use of antibiotics to ensure they are being appropriately administered. But when response to the novel coronavirus ramped up in mid-March, she was pulled into COVID-19 relief efforts exclusively due to her expertise in infectious disease.
“I did no antibiotic stewardship in March, April or May, and I did all hospital epidemiology in March, April and May,” said Cosgrove, past president of the Society for Healthcare Epidemiology in America and director of antimicrobial stewardship at Johns Hopkins Hospital.
During those three months, Cosgrove said use of antibiotics targeted for pneumonia treatment spiked in the hospital setting, largely because COVID-19 patients were overwhelmingly being prescribed these drugs unnecessarily. Johns Hopkins’ experience matches trends nationally, driving concerns among infectious disease experts that antibiotic resistance will continue to worsen as a second wave of COVID-19 cases collides with flu season. The World Health Organization ranked antibiotic resistance as one of its top 10 global public health threats. In the U.S. alone, about 2.8 million drug-resistant infections occur each year, resulting in more than 35,000 deaths. Similar numbers have been reported in the European Union.
Although inroads have been made in combating antibiotic resistance, infection control specialists are worried that misuse of antibiotics on COVID-19 patients—on top of cuts to stewardship programs and burnout of infection control staff—will only worsen the crisis.
“As people prepare for a second wave and there are concerns that healthcare systems may get a lot of critically ill patients, that is going to strain the systems, and antibiotic stewardship programs are already strained, so it really is kind of scary,” said Dr. Michael Stevens, director of the antimicrobial stewardship program at VCU Health in Richmond, Va.