Drug-resistant infections are a grave threat but are loosely monitored; Ky. health facilities must now report them electronically

By Melissa Patrick
Kentucky Health News

Antibiotic-resistant infections are considered one of the gravest threats to humanity, but such infections and the deaths they cause are not routinely reported, hindering the battle against them, Ryan McNeill, Deborah J. Nelson and Yasmeen Abutaleb report for the Reuters news service.

Reporting on their detailed investigation, they write: “Even when recorded, tens of thousands of deaths from drug-resistant infections – as well as many more infections that sicken but don’t kill people – go uncounted because federal and state agencies are doing a poor job of tracking them.”

“You need to know how many people are dying of a disease,” Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy, a Washington-based health policy research organization, told Reuters. “For better or worse, that’s an indicator of how serious it is.”

The report noted many reasons such infections are omitted from death certificates, from poor training in how to fill out the forms to a reluctance of health-care facilities to mention them because “counting deaths is tantamount to documenting your own failures. By acknowledging such infections, hospitals and medical professionals risk potentially costly legal liability, loss of insurance reimbursements and public-relations damage.”

The federal Centers for Disease Control and Prevention estimates that about 23,000 people die each year from 17 types of antibiotic-resistant infections and another 15,000 die from Clostridium difficile, a pathogen linked to long-term antibiotic use, but these numbers are “mostly guesswork” based on “few reported deaths from drug-resistant infection,” Reuters reports.

Michael Craig, the CDC’s senior adviser for antibiotic resistance coordination and strategy, told Reuters that the agency settled on “an impressionist painting rather than something that is much more technical . . . because of our profound concern about the seriousness of the threat.” They said they are working to improve the estimates.

The numbers of uncounted deaths from drug-resistant infections “speak to what can happen when we don’t allocate the necessary resources to bolster … our public health safety network,” U.S. Sen. Sherrod Brown, D-Ohio, told Reuters. “When we see discrepancies in reporting, are unable to finance a workforce to monitor infections, and can’t even soundly estimate the number of Americans that die from [antibiotic-resistant infections] each year, we know we have a problem.”

Brown recently introduced a bill that would require the CDC to collect more and better data on superbug infections and death rates.

Wide variation in tracking

Reuters did a survey of the nation’s health departments and found a wide variation in how seven leading superbug infections are reported, if they are at all.

It found that 17 states report C. difficile infections; 26 states report methicillin-resistant staphlycoccus aureus (MRSA); fewer than half report carbapenem-resistant Enterobacteriaceae (CRE), a family of pathogens that the CDC has deemed an “urgent threat;” and 24 states do not regularly track deaths due to antibiotic-resistant infections. “States that said they
do track deaths generally do so for only a few types of drug-resistant
infections, and not consistently,” Reuters reports.

As of Oct. 1, a new regulation requires Kentucky health-care facilities to report a long list of drug-resistant infections to the Kentucky Department of Public Health electronically. The regulation also requires simultaneous data reporting to the CDC, and allows the agencies to share the data.

“This regulation on encouraging health-care facilities to report is extremely important to track these infections, to learn how to stop these infections and to identify problem areas in the state that need to be addressed,” Dr. Kevin Kavanagh, an infection-control activist who leads the Somerset-based watchdog group Health Watch USA, said in a telephone interview with Kentucky Health News.

Kavanagh said proper reporting will allow examination of the methods health-care facilities use to fight these infections and determine whether they are effective or not. He called the matter a “huge, huge issue in nursing homes.”

In the Reuters survey, U.S. health departments reported about 3,300 deaths from drug-resistant infections in 2003-2014, but the news service’s own analysis of death certificates found 180,000 such deaths during the same time period. More than 20,000 were in California and more than 5,000 were in Tennessee, both states that do not require reporting of deaths linked to such infections.

Reuters found that Kentucky health departments only reported nine deaths related to health care acquired infections between 2003-2014, but Reuter’s investigation found 3,027.

Patient-safety advocates petitioned the CDC in 2011 to add a question about hospital-acquired infections to its standard death certificate, which is used by many states, and have been told that it will be considered the next time the CDC revises its certificate.

Little progress made

Over-prescription of antibiotics and their overuse in farm animals has worsened antibiotic-resistant infections. Also, more people are living with weak immune systems and spending more time in health-care facilities, where most most of these infections occur.

Kavanagh said better reporting could indicate whether the overuse of antibiotics in agriculture plays a large part or a small part in the problem.

Reuters reports that in 2001, a task force led by the CDC, the Food and Drug Administration and the National Institutes of Health declared antibiotic-resistant infections to be a grave public health threat and issued an action plan to tame the problem. The plan included creating a national surveillance program and speeding the development of new antibiotics. But little progress has been made toward these goals.

A new national plan to combat this problem was introduced in 2014. Congress followed in 2015 with “a $160 million increase in the CDC’s budget to bolster research, drug development and surveillance of superbugs by the states,” Reuters reports. But the news service found that states often come up against strong institutional resistance and laws that shield the health-care industry when it comes to surveillance.

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