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Superbugs: The Numbers Don't Lie

Mon, 10/14/2013 - 9:17am
Mike Schmidt, Editor, Surgical Products

If one is to believe the old adage that “Numbers never lie," then the healthcare industry should be very, very worried about the ever-growing problem of superbugs of in hospitals and medical facilities.

A recent report by the Center for Disease Control and Prevention found that every year more than 2 million people in the United States get infections that are resistant to antibiotics.  Of those 2 million, roughly 23,000 die as a result of those of the drug-resistant health threat.

The CDC identified three kinds of bacteria as the most urgent threats:

  • CRE bacteria – carbapenem-resistant Enterobacteriaceae, is a significant and growing threat to hospitals today. The CDC found that about 4 percent of hospitals (and 18 percent of long-term acute care facilities) housed at least one patient with a CRE during the first half of 2012. One type of this bacteria was found in medical facilities in 42 states across the country. To make matters worse, CRE germs kill as many as half of the patients who get bloodstream infections from them. A study published in the March 2013 issue of the American Journal of Infection Control found patients who tested positive CRE took an average of 387 days following hospital discharge to be clear of the organism.
  • C. Diff – Clostridium difficile, is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. According to the CDC, it causes at least 250,000 hospitalizations and 14,000 deaths very year.
  • Neisseria gonorrhoeae – also known as gonococci, or gonococcus, is a species of Gram-negative coffee bean-shaped diplococci bacteria responsible for the sexually transmitted infection gonorrhea.

The aforementioned statistics are sobering. However, they are only made worse by the fact that the prevailing belief among doctors and scientists who study superbugs is that there are a few that are resistant to all antibiotics. Furthermore, it is widely believed we’ll see more as time goes on.
 
In recognition of the problem, the Infectious Diseases Society of America launched its 10 X ’20 Initiative in 2010. The goal of the initiative was to develop 10 new systemic antibiotics by the year 2020. Three years in, it is fair to label the results of the effort as underwhelming. The U.S. Food and Drug Administration (FDA) has approved only one new systemic antibiotic since the IDSA commenced with the initiative – and that was approved approximately more than two years ago, As a result, it seems unlikely the FDA will approved a whopping nine more drugs over the course of the next six years.
 
So what’s a hospital facility to do to combat these types of drug-resistant infections? First and foremost, the CDC has identified four “core actions” to deal with superbugs:

  • Preventing Infection – By that, the CDC means avoiding the infection through conventional contact precautions, hand hygiene recommendations, etc.
  • Tracking – This means collecting information on the bugs to help learn more about how to treat or prevent them.
  • Improving Antibiotic Use/Stewardship – This entails changing the way antibiotics are used and prescribed.
  • Development of Drugs and Diagnostic Tests – New and better drugs will keep healthcare providers ahead of ever-evolving bacteria. Better testing will lead to quicker and more effective treatment options.

While the development of antibiotics has not gone as planned, efforts to improve testing have yielded more encouraging results. A multi-center study in the United Kingdom tested more than 12,000 fecal samples from hospital patients to establish the best method for diagnosing C. Diff. It compared the two most common methods:  a cytotoxin assay, which looks for the presence of C. Diff toxin in fecal samples; and cytotoxigenic culture, which looks to see if there are bugs present in fecal samples that could possibly produce C-Diff toxin.

The research team found that patients with fecal samples positive by the cytotoxin assay were almost twice as likely to die within 30 days as those patients with samples only positive by the alternative 'gold-standard' method (16.6 percent versus 9.7 percent). The findings mean that tests which detect the presence of toxin in fecal samples (the cytotoxin assay) are the most reliable indicators of true C. Diff.

Many hospitals have invested in automated ultraviolet radiation disinfection devices to fight the spread of infections in facilities. Many studies have shown that the devices have been successful in their efforts as a complementary disinfection tool to be used after standard cleaning. However, by no means have they been found to completely eradicate harmful pathogens commonly found in hospitals.

Another study, this one by the Department of Health and Human Services, found that using germ-killing soap and ointment on all intensive-care unit (ICU) patients can reduce bloodstream infections by up to 44 percent and significantly reduce the presence of methicillin-resistant Staphylococcus aureus (MRSA) in ICUs.

While there has been a tremendous amount of research done on this topic, there is still every reason to believe superbugs will continue to be significant issue for hospitals and other medical facilities across the United States and around the globe. While efforts are being made to educate the healthcare industry about superbugs, hygiene, and infection prevention, the results of those efforts are yet unseen. To make matters worse, pharmaceutical and technological developments have not been enough to offset the increased prevalence of these harmful pathogens.
 
As a result, it remains impossible to suggest superbugs are anything but a problem that’s on the rise.

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