Battling Superbugs In Hospitals
http://thedianerehmshow.org/shows/2012-08-28/battling-superbugs-hospitals
Klebsiella pneumoniae on ChromID CPS Agar
Image used under Creative Commons from Flickr user Nathan Reading
Nearly 100,000 people die every year in the U.S. from hospital-borne infections. The most deadly of these are known as “superbugs” for their utter resistance to antibiotic drugs. Last year, one of these superbugs killed six people at the National Institutes of Health and it was months before doctors could locate the source of the infection. New antibiotics are scarce as drug companies consolidate and focus on more profitable drugs. The result is a health care population increasingly vulnerable to untreatable infections. Guest host Frank Sesno and guests discuss the rise in superbugs and what can be done to stop them.
Guests
Dr. Henry Masur
chief of the Critical Care Medicine Department at the National Institutes of Health Clinical Center.
Julie Segre
senior investigator for the National Human Genome Research Institute.
Dr. Michael Bell
deputy director of the Division of Health Care Quality Promotion, Centers for Disease Control and Prevention.
Dr. Edward Cox
director for the Office of Antimicrobial Product, U.S. Food & Drug Administration.
Dr. David Shlaes
president of the Anti-Infectives Consulting.
Comments
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I'm confused about the cycle of the antibiotic-resistant trait and the livestock industry. It seems that if the antibiotic resistance is developed on feed lots, what is the mechanism that carries those bacteria back to the general population?
Well, the way I see it, fighting the so-called superbugs is basically fighting Mother Nature, which is a losing proposition. Man may win few battles, but ultimately cannot win a war against Nature (God?) that created man in the first place, at anywhere - including at hospitals. In this respect, medicine and health care have become the most expensive war against Nature, with the desired outcomes having no better chance than the gambling wins at casinos.
Hey will the Diane Rehm show do an hour show on the Israeli courts decision in favor of Israel against the Rachel Corrie trial. Israel decided in favor of Israel. Surprise. Even Huffington Post (the USA Today/People blog of the internet) put this decision on their front page. Will the Rehm team do a show on this decision. Been a long time since you folks covered any I/P issues. You recently did a one hour show on Hezbollah. Come on about time to cover the other side of this issue
It is my understanding that hospitals do not need to report—or at least do not need to make public—the number of cases of superbugs found at each hospital. I have tried to find this information from my local hospital, where two friends were infected and whose lives have been ruined, with no response. My question: How can I find out a hospital's rate of hospital-acquired infections?
You know, I'd be surprised if any scientist can fully answer your question! My guess is that we still have only murky and incomplete knowledge of how such things really work at molecular level.
You all should speak to how hospitals will be penalized under the new Medicare reimbursement value-based purchasing policies that take into account hospital acquired infections.
As a healthcare provider, I am challenged on a daily basis NOT to prescribe antibiotics unless certain research-based criteria are met (for example, for sinus infections, strep. throat, bronchitis). I do my best not to prescribe and to educate my patients when antibiotics are appropriate. Unfortunately, if 70% of animals in this country are fed antibiotics, and if other healthcare providers cave in to patient demands for antibiotics for viral infections, and if countries such as Mexico allow antibiotics as an over-the-counter purchase at any local pharmacy, I am fighting a losing battle!
Can the guests answer my question? If antibiotics use is overwhelmingly in animals, is this a good case to make for eating organic meat?
Farms are the key. Hospital sewage flows with viral load to sewer facility who clean the water but are left with tons of solid waste, laden with active virus... The entire US switched to spraying this sewage waste on farms in 1993.
At the same time, farm animals are given Ab's they eat the corn fertilized with sewage.
This link is driven by profit seekers and municipalities bent on removing the liability of their own hazardous waste; a rate limiting factor in city growth.
In this day of rhetoric about "cutting regulations and reducing government" this program underscores the need for greater support for NIH and other government programs whose missions are to protect the public's health and not just to created profits for stockholders. Only in this type of environment can colleagues across disciplines fully collaborate rather then compete.
And patients often ask for the "big guns," as the speaker just mentioned. "Levaquin" is the only thing that works for my "sinus infection" even though Augmentin might be the 1st-line therapy in absence of allergies.
Would the guests please comment on the widespread use of broad-spectrum antibiotics in consumer products such as soap?
Duh, why would hospitals do anything to hurt their own image or profit? For ethics? Forget it! It's money before ethics in businesses, including hospitals - at least in America.
Some of our most blatant microbe carriers are the personnel working in and around these same microbes. Many physicians, nurses & others wear their lab coats, neckties, shoes etc. in and out of bacterial contained environments. This is a commonley known occurance but I see no action to correct same. I've seen cardiac interventionalists in my community walking around campus, cafeteria, driving to & fro. This an issue easily corrected by making laws and enforcing same.
It's a basic tenet of the science of Ecology that all monocultures eventually collapse. This is just one card in that collapsing house of cards.
Well, good luck to NIH and it will need lots of it to fight against the health care industry that pretty much owns Washington politicians and the top officials at federal agencies such as NIH, CDC, and FDA.
pleese stop staying jump in on this
Two comments form Extending the Cure, a DC-based research and consultative efforot to contain the spread of antibiotic resistance.
1) Congratulations to Dr. Segre her team at the NIH for this amazing effort to contain the KPC outbreak. However, the average community hospital would not be able to employ active surveillance/isolation and genome sequencing. This is troubling since many nursing home patients are colonized with KPC and may spread it across various healthcare settings. Experience from other countries has shown the need for a coordinated, centralized strategy for surveillance and infection control to contain the spread of these dangerous organisms http://www.blackwellpublishing.com/eccmid20/abstract.asp?id=83424
2) The GAIN act passed by congress provides incentives to develop new antibiotics. However, even with these provisions, the goal of pharmaceutical companies is to sell more dugs, which clashes with the aims of antibiotic stewardship - to prescribe as little as possible, and only when needed. Regulators, healthcare providers and drug companies need to work together towards comprehensive policies that align incentives for drug development and conservation. Find out more at http://www.extendingthecure.org/solutions
I'd like to know why there is not more interest in Bacteriophages? Phage technology has proven to be very effective at killing super bugs. Should we not be shifting our focus away from clumsy antibiotics and toward a more specific therapy?
What about disposal of unused antibiotics? In Denmark where I live, people take unused portions to the pharmacy where they are burned. In the US, I have been told to pour left overs down the drain! Can this be contaminating ground water?
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Disinfectant cleaner manufacturers and suppliers have in the past focused on disinfecting environmental surfaces with little regard to the science of cleaning. PCS is committed to the process of cleaning environmental surfaces properly, with or without disinfectants, to protect public health.
PCS offers a number of Health Canada DIN-registered Disinfectant/Disinfectant Cleaners for use on hard nonporous environmental surfaces in health care facilities, institutions, schools and the hospitality industries. PCS is committed to working with industry cleaning staff, institutional managers, public health officials and infection control to develop and provide the most effective Process Cleaning Solutions and methods, as validated by onsite ATP� monitoring of cleaning efficacy. "
"4. Cleaning to Prevent the Spread of Antibiotic Resistant Bacteria
The European Commission Scientific Committee on Emerging and Newly Identified Health Risks states that current scientific evidence (including bacteriological, biochemical and genetic data) does indicate that the use or misuse of certain active substances in biocidal products in various settings may contribute to the increased occurrence of antibiotic resistant bacteria, both in humans and in the environment. If you would like to learn more click here (pdf). "
Diane -
Please do a program about bacteriophages. One caller today, asked a question about them (the reply was barely comprehensible) and one comment above mentioned them.
A quote from Wikipedia: "They ("phages") have been used for over 90 years as an alternative to antibiotics in the former Soviet Union and Eastern Europe, as well as in France. They are seen as a possible therapy against multi-drug-resistant strains of many bacteria."
Question: Phages are successful in so many other countries - why are they always "dismissed" by the American Medical Establishment.
It seems this would be one way to lower the cost of medical care - and improve - the outcome!
Thank you for the forum you provide!
Marge
The answer is relatively simple. Antibiotic resistance is an example of rapid evolution. What happens is the antibiotics kill the susceptible bacteria. However, a few bacteria are resistant due to genetic mutations (survival of the "fittest". (http://en.wikipedia.org/wiki/Survival_of_the_fittest)). With reduced competition from other bacteria (the dead ones) the resistant bacteria grow rapidly and become the dominant form. When you put the antibiotic back on they are "resistant", not because they developed it but because they had it. However, once the resistance factor has been developed then the clever little bacteria like to share it. They pass it around to other bacteria who then have resistance to the initial antibiotic!
There are those that deny evolution, but it happens every day in microbes and is the cause for antibiotic resistance.
One of the guests mentioned that when you are in the hospital the risk of getting a superbug is low unless you are immunocompromised, but this is not true.
My son is a carpenter and was working at one of the hospitals in Baltimore and got MRSA. He developed very painfull bumps on his thigh and arm and now has scars at those locations. He complained to his boss, but the rule is you either work or you don't get paid. He was working on the floor at the hospital and picking up nails. His insufficient union insurance did not cover his several doctor's visits to cure him and we had to help him out with the bills. My son is in his 20s and is not immunocompromised and developed MRSA.
By the way, children have a tendency to make more contact with the floors than adults and I believe are at greater risk when they visit hopitals.
Thanks to Vahn Lewis for that explanation of natural selection. I was dismayed by the woman panelist’s inability to get away from the metaphor of the bugs being “smart”, even after a caller tried to put her on the right track. That may be an easy shorthand used by reseachers, but given the abysmal state of scientific literacy in the U.S., panelists should explain the evolutionary process at every opportunity.
I’m a big fan of The Diane Rehm Show, but found this particular program to be disappointing in a number of respects, possibly due to the broad reach of this topic. In addition to the constant reference to “smart” bugs, there was little discussion of the role played by the use of antibiotics as a prophylactic and to speed animal growth in agribusiness. And there was a point in the discussion where it would have been natural to clarify that antibiotics are not effective against viruses, but no one said a thing. (It’s true antibiotics may be in order in some cases to prevent a follow-on bacterial infection after an initial viral infection.) Anyway, I found it a frustrating listen, given the missed opportunities to clarify a number of concepts that may not be clear to much of the general public.