Becker's Clinical Quality & Infection Control

8 INFECTION CONTROL 'The damage is done': Experts warn about superbugs, antibiotic overuse amid pandemic By Gabrielle Masson I ncreased misuse and overuse of antibiotics amid the pandemic may be exacerbating antibiotic resistance, according to a Jan. 28 report by National Geographic. In 2019, the U.S. recorded more than 2.8 million antibiotic-resistant infections and more than 35,000 deaths, according to the CDC. Now, antibiotic overuse during the pandemic may be making it worse. Early in the pandemic, many COVID-19 patients were prescribed antibiotics for cough, fever, shortness of breath and X-rays revealing lung inflammation resembling bacterial pneumonia. "When you deal with uncertainty, you err on the side of the prescribing, which is not necessarily the right thing to do," Jacqueline Bork, MD, an infectious disease physician at Baltimore-based University of Maryland Medical Center, told National Geographic. "Many of us were probably overprescribing a good amount of antibiotics. But without a firm understanding of what we were dealing with, we did the best we could at the time." According to a World Health Organization survey taken in late 2020, 35 of 56 countries reported a jump in antibiotic prescriptions. Antibiotics only kill bacteria and are not effective against viruses like SARS-CoV-2. Some physicians have reduced antibiotic use as newer studies have suggested that fungal and bacterial coinfections occur in less than 20 percent of COVID-19 patients. However, severely ill patients with longer hospital stays still may require antibiotics. Experts are warning that more superbugs and increasingly ineffective antibiotics may lead to prolonged hospital stays, higher medical costs and more deaths. Amid worldwide staffing shortages, the Global Antimicrobial Resistance and Use Surveillance System, launched by the WHO in 2015, hasn't had as many resources to report on drug-resistant microbes. While data may not directly reveal a rise of superbugs and its effects just yet, "the damage is done," Pilar Ra- mon-Pardo, MD, regional adviser on antimi- crobial resistance at the Pan American Health Organization, told National Geographic. n Mix-and-match boosters tied to fewer COVID-19 cases, study finds By Mackenzie Bean P eople who receive a COVID-19 booster that's a different brand than their primary vaccine series may be better protected against COVID-19, according to a study from Singapore published Feb. 11 in the Journal of the American Medical Association. Using national data from the Singapore Ministry of Health, re- searchers analyzed the incidence and severity of COVID-19 cas- es between Sept. 15 and Oct. 31, 2021, among people 60 and older eligible to receive booster shots. Of more than 703,000 eligible people, 576,132 received Pfizer or Moderna boosters. People who got the Pfizer vaccine for their primary series and booster had a COVID-19 incidence rate of 227.9 per million per- son-days, compared to 147.9 for people who received Pfizer for the primary series and Moderna for the booster. Among those who had Moderna shots for their primary series, the infection incidence rate was 133.9 cases per million person-years with a Moderna booster and 100.6 per million person-days with a Pfizer booster. Overall, people who got a booster had lower rates of severe COVID-19 than people who did not. "The study results support recommendations for vaccine boost- ers and suggest that heterologous boosting may provide great- er protection against COVID-19," researchers concluded. n Booster efficacy wanes after 4 months, CDC finds By Erica Carbajal T he effectiveness of mRNA COVID-19 boost- ers drops after about four months, though they still offer significant protection against hospitalization, according to a CDC study conducted during the omicron surge. The CDC's Feb. 11 "Morbidity & Mortality Weekly Report" found vaccine efficacy against emergency department and urgent care visits for COVID-19 was 87 percent during the first two months after receiv- ing a booster, dropping to 66 percent by the fourth month. Meanwhile, protection against hospitaliza- tion was 91 percent in the two months after the third dose, falling to 78 percent after four months. "For both delta- and omicron-predominant periods, [vaccine efficacy] was generally higher for pro- tection against hospitalizations than against [ED/ urgent care] visits," researchers said. "All eligible persons should remain up to date with recommend- ed COVID-19 vaccinations to best protect against COVID-19-associated hospitalizations and ED/UC visits." The findings are based on a multistate analysis of 241,204 ED/urgent care visits and 93,408 hospital- izations among adults with COVID-19-like illness between Aug. 26, 2021, and Jan. 22, 2022. n

• Cover