With the United States facing an increasing number of drug-resistant “superbugs,” federal health officials said a relatively simple solution could prevent more than half a million of the most deadly infections over five years.
Hospitals or nursing homes try to control infections on their own, but they rarely tell each other when a patient being transferred into another facility is carrying antibiotic-resistant bacteria. That lack of information greatly increases the risk that the germ will be spread.
A coordinated approach, in which health facilities in a region share data with a central public health authority — which in turn distributes the information — could sharply improve detection and save tens of thousands of lives, the Centers for Disease Control and Prevention said in a report released Tuesday.
The CDC researchers focused on infections caused by four of the most aggressive pathogens: Clostridium difficile, or C. diff, which attacks the gut when antibiotics kill off weaker germs; carbapenem-resistant Enterobacteriaceae, or CRE, which the CDC has labeled a “nightmare” germ because it is resistant to nearly all antibiotics and kills up to half of patients who get bloodstream infections; a multi-drug-resistant Pseudomonas aeruginosa, which can cause serious infections for hospitalized patients or those with weakened immune systems; and invasive methicillin-resistant Staphylococcus aureus, or MRSA, which is spreading not only in health-care facilities but also in schools, day cares and other places in communities.
According to current trends, infections from just these four pathogens could increase by as much as 10 percent over a five-year period, to 340,000 annually, the report said. But aggressive intervention using a coordinated approach could prevent 619,000 such health-care-associated infections and 37,000 deaths over five years, the researchers said. They estimate the approach would save the health-care system nearly $8 billion in treatment costs.
Overall, antibiotic-resistant germs cause more than 2 million illnesses and at least 23,000 deaths each year in the United States. Combating antibiotic-resistant bacteria is a major focus for the White House, which has asked Congress for about $130 million for the CDC to work with health-care facilities in all 50 states to detect and prevent antibiotic-resistant germs and C. diff infections.
“This is something that we simply must do to protect the health and lives of Americans,” CDC Director Tom Frieden said in a call with reporters.
Using mathematical modeling, researchers found infection rates of CRE could be drastically cut, in some cases by as much as 74 percent, if hospitals and nursing homes in the same area coordinated their efforts. Under that scenario, hospitals and nursing homes were able to find out about outbreaks of drug-resistant germs from a public health agency that received data from each institution and shared it with all the others. The facilities then were able to take faster action to curb the spread between facilities.
Several states have already begun to take a coordinated approach, the report said. South Dakota now requires health-care facilities to report cases of CRE, contributing to a drop in infections over two years. Tennessee uses infection data to focus on hospitals or nursing homes with the highest number of C. diff infections. Illinois maintains a registry of patients infected with or carrying CRE so facilities can know on the same day whether a new patient previously has tested positive for CRE.
Testing every patient at the time of admission is not feasible, and sometimes test results come too late, experts say.
Over two-thirds of states require health-care-associated infections to be reported to state health departments. But many health departments do not have the resources to implement this kind of coordinated approach, said John Jernigan, a top CDC official. That’s why the CDC’s budget request includes funding to support state surveillance and lab investments needed to make this approach work, he said.
The CDC tracks some health-care-associated infections from the majority of the country’s acute-care hospitals. But the data does not include CRE and other resistant organisms. And most of the country’s nursing homes do not participate in that tracking system.