Fifteen years after the U.S. government declared antibiotic-resistant infections to be a grave threat to public health, a Reuters investigation has found that infection-related deaths are going uncounted, hindering the nation’s ability to fight a scourge that exacts a significant human and financial toll.
Even when recorded, tens of thousands of deaths from drug-resistant infections––as well as many more infections that sicken but don’t kill people––go uncounted because federal and state agencies are doing a poor job of tracking them, according to the Reuters report.
As America learned in the battle against HIV/AIDS, beating back a dangerous infectious disease requires an accurate count that shows where and when infections and deaths are occurring and who is most at risk. Doing so allows public health agencies to quickly allocate money and manpower where they are needed. But the U.S. hasn’t taken the basic steps needed to track drug-resistant infections, Reuters found.
For example, drug-resistant infections are routinely left off death certificates. Doctors and other clinicians get little training in how to fill out the forms, Reuters said, and some don’t want to wait the several days it can take for laboratory confirmation of an infection. Moreover, an infection’s role in a patient’s death may be obscured by other serious medical conditions.
There is also a powerful incentive not to mention hospital-acquired infections: Counting deaths is tantamount to documenting a hospital’s failures. By acknowledging such infections, hospitals and medical professionals risk potentially costly legal liability, the loss of insurance reimbursements, and public-relations damage.
In the absence of a unified national surveillance system, the responsibility for monitoring drug-resistant infections and related deaths falls on the states. A Reuters survey of the health departments of all 50 states and the District of Columbia found wide variations in how they track seven leading “superbug” infections––if they do so at all.
Only 17 states require notification of Clostridium difficile infections, for example, while just 26 states and Washington, D.C., do the same for methicillin-resistant Staphylococcus aureus (MRSA). Fewer than half require notification of infections by carbapenem-resistant Enterobacteriaceae (CRE), a family of pathogens that the CDC has deemed an “urgent threat.” CRE gained notoriety when more than 200 people were sickened through contaminated medical scopes in hospitals from 2012 to 2015.
Among the states that don’t require reporting of superbug deaths is California, the nation’s most populous state. The Reuters analysis identified more than 20,000 deaths linked to drug-resistant infections between 2003 and 2014, the most of any state. A health department spokeswoman told Reuters that the state legislature authorized the department to be notified of infections, but not deaths.
Tennessee doesn’t require notification of deaths, either. The Reuters analysis found more than 5,500 deaths linked to superbugs there––more than half of them MRSA-related.
Connecticut, with a grant from the CDC, is the only state that closely monitors MRSA deaths. It logged 2,084 deaths from drug-resistant infections between 2003 and 2014, all but 10 from MRSA. That’s nearly twice the number of deaths from MRSA in the state that Reuters found in its death certificate analysis.
While the types of bacteria showing drug resistance have multiplied, the federal government requires hospitals to report infections for only two of them, MRSA bacteremia and C. difficile infection. It requires limited reports on the others and relies on the states to fill in the gaps.
In 2001, a task force led by the CDC, the FDA, and the National Institutes of Health declared antibiotic-resistant infections to be a grave public health threat and issued an action plan to control the problem. The group’s recommendations included creating a national surveillance plan and speeding development of new antibiotics. And yet not a single new class of antibiotics has been approved for medical use since 1987, Reuters points out. Further, despite years of efforts to educate health care workers about infection control, multiple studies show that many still routinely flout even basic preventive measures, such as hand-washing.
Source: Reuters; September 7, 2016.