Kim Leuthner, PharmD, FIDSA, comments on the effect of COVID-19 on the epidemiology of complicated UTIs, the use of antibiotics, and antimicrobial resistance.
Kim Leuthner, PharmD, FIDSA: What were the effects of COVID-19 on the epidemiology of complicated UTIs [urinary tract infections]? Unfortunately, COVID-19 set back a lot of stewardship, infection prevention, and other practices that many institutions across the United States had been putting in place toward preventing the spread of multidrug-resistant infections. Some of the complications have to do with the supply chain issues, where we couldn’t put patients in appropriate isolation. That allowed for organisms to spread a little easier. We’re talking about patients who have to be hospitalized for significantly longer periods of time with a lot more antibiotic exposure, which alters the floor of the institutions, causing a higher risk for not only colonization but infection with multidrug-resistant bugs. It did us a disservice and set us up for almost having to start all over again.
What changes have there been in the use of antibiotics? At my institution [University Medical Center of Southern Nevada], we’ve tried to not let it affect as many places. Ours is a relatively focused—for lack of a better description—seek-and-destroy stewardship program that allows for empirical use but is proactive about de-escalating therapies based on cultures and sensitivities. Unfortunately, with the rise of overuse of antibiotics due to COVID-19, more patients are having infections with these agents and these multidrug-resistant pathogens; therefore, we have to allow for use of the broader-spectrum therapies for longer periods. I’m hoping that by getting back to normal and better infection-prevention practices, with supply chain improvements, we’ll get back on track and these numbers will go back down.
What changes have we seen in terms of positive pathogens and complicated UTIs since the COVID-19 pandemic? I’m happy to report that, at least at my institution, the organisms themselves haven’t changed. We’re still seeing our gram-negative causes, E coli, and Klebsiella pneumoniae. It’s mostly the GI [gastrointestinal] flora resulting in these infections. The big difference is the prevalence of the resistant pathogens because of the higher incidence of antibiotic use and the change in the prevalence of resistant pathogens in all institutions—hospitals, nursing homes, rehab facilities. It’s still a reasonable choice…as are empirical cost pathogens. The gamble is whether this is going to be multidrug resistant or just slightly resistant?
Have there been any changes in multidrug resistance since the pandemic, and what are the potential causes? Unfortunately, we’re seeing more multidrug-resistant gram-negatives becoming a problem in institutions. This is directly driven by the continued use of antibiotics to try to treat a viral infection. COVID-19 was a complicated and unknown realm for a lot of practitioners. Because most of the information was developing as the pandemic was developing, we did our best to make sure patients were treated adequately and appropriately. Whenever you’re talking infections, many times that results in antibiotic use. Trying to de-escalate, trying to narrow therapy, became very difficult because these patients ultimately were hospitalized for long periods and developed multiple coinfections or secondary infections. Antibiotic use during this time frame probably skyrocketed in many institutions which can then select out for more of the resistant pathogens to stick around.
Transcript Edited for Clarity