Impact of COVID-19 Immune Dysfunction on Antibiotic Resistant Bacteria- PACCARB Presentations 
Dr. Kevin Kavanagh gives a short discussion regarding the impact of immune dysfunction caused by COVID-19 and its impact on antibiotic resistant organisms. It is stressed that exposure needs to be prevented and similar to the protocols used by the Veterans Health Administration system, surveillance and contact precautions are of utmost importance.  PACCARB Oral Comment Jan. 24, 2023. https://youtu.be/8QYfp7KSd20    Download Written Comment
 
====================================================================
 
As the committee is aware, the CDC has reported1 an increase in antibiotic resistant infections during the COVID-19 pandemic, including Candida auris, Group A and B Streptococcus, Salmonella and ESBL resistant Enterobacterales. There is even a more concerning increase in resistance in hospital onset infections, including Candida auris, CRE, ESBL resistant Enterobacterales, Vancomycin Resistant Enterococcus, drug resistant Pseudomonas and MRSA.

There is concerning evidence that the rise this resistance will be compounded by a lasting immune dysfunction produced by COVID-19.2 The recent surge in hospitalizations from the respiratory syncytial virus in the United States exemplifies this problem. Not widely reported by the lay press, the United States, Germany and Sweden had large RSV surges last year, shedding significant doubt on the “immune debt” hypothesis. Sweden also had very little masking and few closures during the pandemic. Immune dysfunction from COVID-19 is also supported by clinical studies and abundant laboratory evidence.

A non-peer reviewed study observed almost a 100% increased risk of RSV infections in COVID-19 patients. 9.7% of children who did not have an RSV infection had a documented COVID-19 infection, this contrasts with 19.2% of children who developed an RSV infection that had a documented COVID-19 infection.3 Another study found a 34% increased risk of Streptococcal tonsillitis in COVID-19 patients compared to controls.4

The best prevention is to mitigate patient exposure to the drug resistant pathogen. Screening and surveillance must become a leading strategy upon which others are added. In the case of hospital onset MRSA infections, private sector healthcare in the United States experienced approximately a 17% increase above their 2010-2011 baseline; as the Veterans Health Administration, with a uniform strategy of surveillance and contact precautions, experienced a 83.6% decrease.5

We need to remember that no matter how high risk a patient is, one will only become infected to a drug resistant pathogen if one is exposed to it.

References:
1. 2022 Special Report COVID-19. Centers for Disease Control and Prevention. Jan. 16, 2023. https://www.cdc.gov/drugresistance/pdf/covid19-impact-report-508.pdf
2. Kavanagh KT. Immunodysfunction, a Cause of Stealth COVID-19 Illness & Deaths. Infection Control Today. Jan. 17, 2022. https://www.infectioncontroltoday.com/view/immunodysfunction-a-cause-of-stealth-covid-19-illness-death  
3. Wang L, Davis PB, Berger NA, et al. Disruption in seasonality, patient characteristics and disparities of respiratory syncytial virus infection among young children in the US during and before the COVID-19 pandemic: 2010-2022. MedRxiv. Nov. 29, 2021, https://www.medrxiv.org/content/10.1101/2022.11.29.22282887v1 
4. Mizrahi B, Sudry T, Flaks-Manov N, et al., Long covid outcomes at one year after mild SARS-CoV-2 infection: nationwide cohort study. The BMJ. January 11, 2022. https://www.bmj.com/content/380/bmj-2022-072529 
5. Kavanagh KT, Cormier LE, Success and failures in MRSA infection control during the COVID‑19 pandemic. Antimicrobial Resistance and Infection Control. Sept. 25, 2022. https://aricjournal.biomedcentral.com/articles/10.1186/s13756-022-01158-z