CMOs Should be Addressing Antimicrobial Resistant Pathogens

The incidence of six bacterial antimicrobial-resistant hospital-onset infections increased in 2022 compared to 2019, according to a recent report from the Centers for Disease Control and Prevention (CDC).

The spike in antimicrobial resistant pathogens was likely caused by the impact of the coronavirus pandemic, according to the CDC. Drivers of the spike include longer lengths of stay, disruption of infection prevention practices, and increased inappropriate antibiotic use, the CDC says.

The increased incidence of antimicrobial resistant pathogens should be a top concern for CMOs, according to Anurag Malani, MD, medical director of hospital epidemiology, antimicrobial stewardship, and special pathogens at Trinity Health St. Joseph Mercy, which is part of Livonia, Michigan-based Trinity Health.

“CMOs should be concerned about antimicrobial resistant pathogens because patients who have these infections do not do as well as other patients,” Malani says. “Their outcomes are not as good. They are more difficult to treat. They stay in the hospital longer. They incur more costs.”

Additionally, an antimicrobial resistant infection in a patient can spread to other patients, which is a risk, he says, adding that these infections can increase mortality rates.

The CDC report found increased incidence of the following antimicrobial-resistant hospital-onset infections during the pandemic:

• Carbapenem-resistant Enterobacterales
• Carbapenem-resistant Acinetobacter
• Candida auris
• Vancomycin-resistant Enterococcus
• Extended-spectrum beta-lactamase producing Enterobacterales
• Multidrug-resistant Pseudomonas aeruginosa

Among the seven antimicrobial-resistant hospital-onset infections monitored by the CDC, only methicillin-resistant Staphylococcus aureus showed no sign of increasing during the pandemic. The incidence of Candida auris rose five-fold from 2019 to 2022.

Trinity Health St. Joseph Mercy has seen similar patterns with antimicrobial resistant pathogens as the CDC data, with several infections that have been difficult to treat in 2024, according to Malani.

“For example, Candida auris is a type of fungal infection that is very difficult to treat,” Malani says. “Its prevalence in Michigan is much higher than it was pre-pandemic. It has become common in hospitals across Michigan.”

Antimicrobial resistance can be hard to measure, according to Malani.

“It is hard to measure at a local site because you do not practice care in a vacuum,” he says. “It is evolving, and it is impacted by other hospitals and health systems.”

That is why data from the CDC and the agency’s National Healthcare Safety Network is crucial for health systems and hospitals to understand the evolution of antimicrobial resistant pathogens, Malani says.

“We are going to be able to use this data in a region, in a state, and across health systems to help us in terms of surveillance,” he says.

“Antimicrobial stewardship programs review patients, review whether patients have infections, determine whether patients are on the right antibiotics, and make sure patients are on the right duration of antibiotics,” he says.

Hospitals have regulatory and accreditation standards around both antimicrobial stewardship and infection prevention, according to Malani.

“For example, if you are accredited by The Joint Commission, then you must have an antimicrobial stewardship program and an infection prevention program,” he says.

The Centers for Medicare & Medicaid Services, which is the country’s largest healthcare payer, also require hospitals to have antimicrobial stewardship and infection prevention programs, according to Malani.

Health systems and hospitals should also consider tying infection prevention and antimicrobial stewardship practices together.

“Across the continuum of care, we definitely need resources and expertise to do that,” Malani says. “Many healthcare settings do not have that expertise. They don’t necessarily have the funding, and they may not have the resources.”

Looking to the future of antimicrobial resistant pathogens, there is cause for concern, according to Malani.

“Regarding my expectation for next year, antimicrobial resistance is here,” he says. “We are going to have to figure out large-scale strategies to try to reduce the pressures on antimicrobial resistance. It could be more than how we use antibiotics.”