Authorities in both the United States and Great Britain are outlining a potentially catastrophic threat to public health: a spike in the appearance of drug-resistant bacteria in healthcare institutions. And there's reason to believe that the so-called "superbug" could be a longer-term problem here, especially given the lack of a response plan and especially for older people in the U.S. No location is exactly safe, but before you freak out, here's some much needed context.
Last week, the Centers for Disease Control held a press conference to brief reporters on CRE; officially, carbapenem-resistant Enterobacteriaceae. In layman's terms, CRE are bacteria which live inside the body but can cause infections if they travel out of the gut. The title "Carbapenem-resistant" indicates those bacteria resistant to a particular class of antibiotic — an increasing occurrence. Subsequent interviews with health officials have, in turn, seen an increasing occurrence of words like "catastrophic" being bandied about.
Here’s what the CDC announced Tuesday:
- Healthcare institutions in 42 states have now identified at least one case of CRE.
- The occurrence of this resistance in the overall family of bacteria has risen at least four-fold over 10 years.
- In the CDC’s surveillance networks, 4.6 percent of hospitals and 17.8 percent of long-term care facilities diagnosed this bug in the first half of 2012.
Those are dire reports.
The CDC data breaks down as follows. Bars below indicate the number of surveyed medical facilities that demonstrated the presence of CRE.
In the following chart, "Other" includes military facilities and American territories.
The CDC also has a map tracking the detection of CREs by state.
But as McKenna notes, it's not necessarily complete.
CRE is not what public health calls a “reportable disease”; according to the CDC, only six states require that physicians or hospitals tell the rest of the world they have diagnosed it. (Three others are “considering” making it reportable.) Plus, surveillance for CRE is patchy; yesterday’s CDC report comprised data from three different surveillance systems. . And also, there are carbapenem-resistant bacteria causing outbreaks in the US which are not counted as CREs because the bacteria are not Enterobacteriaceae.
So don't get too cocky, Nebraska and Idaho.
Or England. The United Kingdom's Chief Medical Officer, Dame Sally Davies, who threw out the "catastrophic" line on Monday, echoed similar concerns as the CD in a report released last week. The Guardian reports:
These so-called "gram negative" bacteria, which are found in the gut instead of on the skin, are highly dangerous to older and frailer people and few antibiotics remain effective against drug-resistant strains.
As many as 5,000 patients die each year in the UK of gram negative sepsis – where the bacterium gets into the bloodstream – and in half the cases the bacterium is resistant to drugs.
That data on "older and frailer" patients also echoes the CDC's findings; many of the large, long-term facilities in which CREs were found were homes for the elderly. Davies suggested a possible worst-case scenario: a return to pre-antibiotic healthcare conditions.
If tough measures are not taken to restrict the use of antibiotics and no new ones are discovered, said Dame Sally Davies, "we will find ourselves in a health system not dissimilar to the early 19th century at some point".
Those measures will be easier to take in the UK than here. After outlining key measures that should be taken, McKenna takes a somber note:
[N]one of this is required, and none of this is funded. … [H]ospitals are on their own in figuring out how to organize and pay for CRE control. There are no reimbursements, under Medicare, for infection-control as a hospital task; and as infection-prevention physician Eli Perencevich demonstrated two years ago, the National Institutes of Health is not funding resistance-countering research.
Let's hope the invisible hand of the free market has been washed recently.
The Washington, D.C., Center for Disease Dynamics, Economics, and Policy offers a tool to track the growth of resistant bacteria over time. Like, for example, Carbapenem-resistant K. pneumoniae.
It's grown fast, but still represents less than five percent of incidents of infection. Compare that to A. baumannii, an aerobic strain — not a CRE.
Nearly 40 percent of this bug is now resistant. And for those who take solace in the map above, a note of caution: As McKenna notes, this bacterium isn't classified as a CRE. Meaning it's not counted in the most alarming datapoint from the CDC's research: Of the 72 cases of CRE it considered, 82 percent required hospitalization, with 16 percent in the ICU. Four percent of patients died. Hang in there.