Periods of high influenza activity in the United States seem to correspond with high rates of antibiotic resistance in both respiratory and nonrespiratory infections, researchers found.

Kalvin Yu

“These associations do not imply causality, as the causes of [antibiotic resistance] are multifactorial,” Kalvin Yu, MD, FIDSA, vice president of medical and scientific affairs at Becton, Dickinson and Company, and colleagues wrote in Open Forum Infectious Diseases. “However, they provide important insights into [antibiotic resistance] trends that may help health systems strategically allocate resources, including vaccination drives and antimicrobial stewardship initiatives.”

Yu said they conducted the study “because we had seen seasonal fluctuations in both resistance patterns and select antimicrobial use during what appeared to be periods of flu peaks.”

“Frontline clinicians have anecdotally reported encountering increasing bacterial resistance in patients during cold and flu season, possibly due to a surge in more complicated patient admission,” Yu told Healio. “To our knowledge, there has not been validation of this in any large-scale research.”

Yu and colleagues used a Becton, Dickinson and Company database to evaluate antibiotic susceptibility profiles from patients aged older than 17 years at 257 health care facilities between 2011 and 2019. They investigated antibiotic resistance in gram-positive and gram-negative bacteria and used modeling to evaluate monthly trends in antibiotic resistance and associations with community influenza rates.

Overall, they identified more than 8.2 million pathogens — 154,841 gram-negative carbapenem-nonsusceptible, 1,502,796 gram-negative fluoroquinolone-nonsusceptible, 498,012 MRSA, and 44,131 nonsusceptible S. pneumoniae. They found that all S. pneumoniae rates per 100 admissions (macrolide-, penicillin-, and extended-spectrum cephalosporins-nonsusceptible) and respiratory MRSA were associated with influenza rates. For gram-negative pathogens, influenza rates were associated with fluoroquinolone-nonsusceptible Enterobacterales, fluoroquinolone-nonsusceptible Pseudomonas aeruginosa, and carbapenem-nonsusceptible Acinetobacter baumannii species.

“It’s our hope that these findings may inform targeted antimicrobial stewardship initiatives from a clinical and operational perspective in preparation for and during cold and flu season and provide much-needed support for vaccination programs, which would decrease secondary bacterial coinfections and resulting antibiotic use,” Yu said.

“Because our data collection ended in 2019, more research is needed to better understand changes in antibiotic treatment patterns in response to COVID-19 infections, particularly for those living with underlying or chronic conditions.”