By Sara Reardon
In her regular job, Priya Nori runs Montefiore Medical Center’s antibiotic stewardship program, and spends most of her time ensuring that the Bronx-based hospital doesn’t overuse the drugs and allow bacteria resistant to them to thrive. But like many physicians, Nori is now spending all of her time helping treat COVID-19 patients at her New York City hospital, which like other medical centers in the pandemic hot spot, is crowded with 50% more patients than normal. As part of that care, she and other doctors are administering many more antibiotics than normal, which is a recipe for the rapid rise or spread of resistant bacteria, especially given the crowded conditions.
Antibiotics do not directly affect SARS-CoV-2, the respiratory virus responsible for COVID-19, but viral respiratory infections often lead to bacterial pneumonia. Physicians can struggle to tell which pathogen is causing a person’s lung problems. “We tend not to hold back on antibiotics in these patients,” Nori says, especially when that decision could mean life or death. “Is that a bad thing right now? I have trouble saying that it is.” But she and others worry the surge of COVID-19 patients could ultimately lead to a surge in antibiotic-resistant bacteria—a concern serious enough that the U.S. Department of Defense (DOD) is assembling a group of at least 10 medical centers to study “secondary” bacterial and fungal infections in these patients and the antibiotics being used to prevent them.
Hospitals, particularly intensive care units, are hotbeds of antimicrobial resistance, and they have long been struggling to rein in the use of antibiotics. But COVID-19 has put many such efforts on hold. Although the U.S. Centers for Disease Control and Prevention requires medical centers to report their antibiotic use and the rates of infections acquired in the facility, Nori and other physicians say compliance has fallen off in the pandemic.
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