U.S. fiddles while superbug spreads
Ronald Hale went to the Royal Alexandra Hospital in Canada last month with a lung problem, but instead of being helped, he was killed by the superbug carbapenem-resistant enterobacteriaceae. The germ, which had been brought into the hospital by a female patient initially treated outside Canada, put him into septic shock and caused organ failure. He died hours later. And as health officials vowed to stop CRE from gaining a foothold, Hale’s death made headlines.
Canadians can look south to the U.S. to see the consequences of inaction. According to the U.S. Centers for Disease Control and Prevention, the superbug CRE was first uncovered in North Carolina in 1999. By 2008, it had spread to 24 states and was “routinely” seen in certain New York and New Jersey hospitals. But hospitals kept quiet. Now it’s in at least 43 states.
CRE infections could make going to hospitals in affected areas too perilous. National Institutes of Health researchers report that up to half of patients who get CRE infections die from them. Cleveland Clinic researchers say the death rate is 72 percent for patients with CRE bloodstream infections. Few, if any, antibiotics work against this germ.
Two months ago at a press conference, CDC Director Thomas Frieden dubbed CRE the “nightmare bacteria,” warning that “without urgent action now,” superbugs like CRE will prevent patients from getting joint replacements, cancer therapy and other treatments. The risk of incurable infections will make these treatments too dangerous. Yet, where’s the urgent action?
The CDC doesn’t even have accurate data on how many CRE infections are occurring and where, because according to the director of the CDC’s Office of Antimicrobial Resistance, Steven Solomon, the government agency has never reached out to state officials to make CRE a reportable disease. Only 12 states require hospitals to report cases. Astoundingly, New York state did not require reports until July 2013, despite CRE menacing some of its hospitals for a decade.
The CDC urges doctors to curb overuse of antibiotics — but that’s a long-term strategy. It’s like responding to Hurricane Sandy with talk about climate change but no plans for bulkheads and flood controls. The CDC’s new 114-page report “Antibiotic Resistance Threats in the United States, 2013” makes only a single mention of the need for more thorough cleaning in hospitals.
CRE travels from patient to patient through unclean hands, inadequately cleaned ventilators and other equipment, and even nurse uniforms and curtains. It can attack one patient, and then weeks later, attack another, who had no contact with the prior victim.
This is what happened at the National Institutes of Health Clinical Center in Maryland in 2011. A 43-year-old woman known to have CRE was admitted from a New York City hospital. The NIH treated her, using CDC infection-control precautions, but three weeks later, a male cancer patient who had had no contact with her came down with CRE. Week after week, more and more patients contracted the infection introduced by the New York woman. Six of those patients ultimately died, one of whom was a 16-year-old boy.
To stop the outbreak, NIH investigators double-cleaned rooms with bleach and misted hydrogen peroxide in measures far beyond what the CDC recommends.
When CRE invaded Israel’s hospitals in 2006, public health authorities launched a military-style campaign requiring reports from all hospitals, which were ordered to test patients and undergo rigorous cleaning efforts. This reduced CRE by 70 percent in one year. Israeli researchers just announced a drug that may protect patients exposed to CRE from becoming infected.
The problem in the U.S. is a lack of will. When the first superbug MRSA emerged in the 1970s, the U.S. equivocated, while Denmark and Holland adopted severe patient-testing methods, which tamed the outbreaks. Health Watch USA researchers conclude that if the U.S. had acted with similar rigor, as many as 85 percent of these infections might have been prevented.
The result is needless deaths. Families USA estimates that 26,000 people a year die because they are uninsured, and so their care is delayed — a fact impelling the nation to act. But four times as many people die needlessly from hospital infections each year. Where is the outrage for these victims?