NIH should have told public of superbug

Robert McCartney
Columnist August 25, 2012

The scariest thing about the superbug that killed six people at the National Institutes of Health in Bethesda last year is that such dangerous germs have become so common in U.S. hospitals that doctors viewed the outbreak as routine and saw no need to inform the public.

The decision to keep the episode secret until last week has triggered a mild uproar, and deservedly so. A top Maryland health official conceded that the state, which was told of the problem in December, erred by neglecting to notify Montgomery County authorities.

Robert McCartney’s column on local issues appears Thursdays and Sundays in The Post’s Metro section. View Archive

“That was just a mistake on our part,” said State Epidemiologist David Blythe. “We do try to keep county health departments informed.”

People who live or work near the sprawling NIH campus had a right to know that their neighbors at one of the world’s most prestigious hospitals struggled desperately for months with an infection immune to antibiotics.

“Even if it might have caused a little panic, I think the public should have been notified,” said James Lafley, 62, a construction project manager who works in Bethesda. “Knowing NIH had a hard time containing the bug, it could have gotten outside the hospital population.”

All but one of a dozen people interviewed Friday in downtown Bethesda said NIH should have been more forthcoming. Separately, some institute workers who are regularly exposed to the affected wards in the Hatfield Building at the NIH Clinical Center grumbled that they should have been told.

“A lot of people were saying, ‘Hey, this went on under our noses and we didn’t know,’ ” said an NIH service employee with more than five years experience, who spoke on the condition of anonymity for fear that supervisors might retaliate. “People who have to do a job, do they know what they’re walking into?”

Admittedly, all past experience suggests that the drug-resistant strain of Klebsiella pneumoniae would not have sickened anybody outside the NIH clinic. The only people previously killed by the bacteria have been those already very sick, such as with cancer, and plugged into intravenous tubes or other invasive equipment that provides entry routes for infection.

However, the whole point about these frightening organisms is that they’ve mutated into a more threatening form — which means they might do so again. The drug-resistant bacterium known as MRSA used to be confined to hospitals but is now showing up outside health-care settings.

“There is not a high risk of spread of this [NIH] bacteria outside of nursing homes and hospitals at this time, although that could change. It is theoretically possible that we would see this bacteria spread in communities,” said Brad Spellberg, a Los Angeles physician who is co-chairman of a microbial resistance task force for the Infectious Diseases Society of America.

Still, what’s most worrisome for now is the fact that these hard-to-treat microbes have become such a big problem in hospitals that the episode at NIH didn’t prompt authorities to take special measures to notify anybody.

“This [superbug] is very common in the New York/New Jersey area, both in hospitals and skilled nursing facilities,” said Dr. Henry Masur, chief of critical-care medicine at the NIH center where the problem occurred. “We are one of at least a half-dozen hospitals in [Montgomery] county that have this organism.”

Infections acquired in hospitals kill nearly 100,000 people a year in the United States, and the vast majority are caused by antibiotic-resistant bacteria. Masur and others recommended various steps to combat the problem. One is to make it more financially attractive for pharmaceutical companies to develop new antibiotics. Another is to minimize use of existing antibiotics, so fewer germs become resistant.

Last year’s superbug outbreak became public Wednesday only because NIH researchers published a scientific article describing groundbreaking research techniques they used to track the bacteria within the hospital.

Spellberg said NIH deserved praise for going public at all, and with so much detail, given that most hospitals prefer to avoid talking about superbug outbreaks.

“I thank the NIH for having the moral courage to come forward publicly. Other hospitals haven’t done that,” Spellberg said.

Maybe so, but I think we should have known last autumn, when NIH realized it had serious trouble. One who agreed with me is former U.S. congresswoman Connie Morella (R-Md.), who represented Montgomery County for many years. She happened to be one of the people I interviewed in Bethesda, where I accosted her as she arrived at the iconic Tastee Diner.

“They should have a policy for telling the public about it. They’re part of our community,” Morella said. She said NIH would be capable of managing any public hysteria: “They can handle that. They’ve got good PR.”

For previous Robert McCartney columns, go to washingtonpost.com/mccartney.

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