ADVERTISEMENT
  About the SA Blog Network













Molecules to Medicine

Molecules to Medicine


Demystifying drug development, clinical research, medicine, and the role ethics plays
Molecules to Medicine Home

The NIH Superbug Story—a Missing Piece

The views expressed are those of the author and are not necessarily those of Scientific American.


Email   PrintPrint



Considerable attention has been given to this week’s news about hospital (healthcare) acquired infections (HAI) at NIH with a “superbug.” *

There has been probably misplaced criticism of NIH for not making its finding of transmission of a bacteria between patients public, as well as wonder at the high-tech tools that enabled NIH to track down this killer organism.

These articles all overlook the more basic underlying problems, which I am aware of because of my practice as an Infectious Disease physician.

These relatively new, highly resistant strains of bacteria—carbapenem resistant Gram negative bacteria as Klebsiella and Acinetobacter—are not just at NIH. This is a widespread problem throughout much of the country.

I am called to treat highly resistant bacteria like this regularly. These isolates are relatively common in nursing homes and LTACs (long-term acute care centers, often used for patients with prolonged need for ventilator care), and are transferred to hospitals when these more chronically ill patients are transferred to a hospital for an acute problem. In some of these long-term care settings, the resistant bacteria becomes endemic, and the centers become breeding grounds and reservoirs for resistant organisms.

There have been marked attitudinal changes in this country that I have witnessed over the past 30+ years I have cared for patients, fueling the emergence of resistant organisms.

First is the unrealistic expectation in the U.S. that people will live forever, if only enough technology and resources are spent on them.

A corollary is that we almost never letting anyone die in peace. Even if a patient has a living will and has made their explicit wishes known, too often a family member (and sometimes, physicians as well) will challenge the decision to allow a natural death. And ethics committees and state regulations tend to err on the side of treatment rather than acknowledging that care is futile and against the patient’s wishes. So we throw more antibiotics at the patient, because of this “obligation” to continue treatment…and the bacteria become more resistant and the healthcare workers more burned out.

Combine the burnout and emotional toll on healthcare workers of providing futile care day after day with short staffing in the name of cost savings, and you have a recipe for further transmission of infections between patients.

The NIH story is but the tip of the iceberg. Until the issue of futile care is addressed and there is consensus regarding the “community” good vs. an individual’s “right” to care, no matter how futile nor what risk that poses to others, we will not win this battle against increasingly resistant bacteria.

(Note: I will expand and add references when time permits; I’m traveling.)

References:

Gina Kolata: Genome Detectives Solve a Hospital’s Deadly Outbreak

Ed Yong Genome detectives unravel spread of stealthy bacteria in a hospital

Deborah Blum Hunting a Superbug

Brian Vastag NIH should have notified it of superbug outbreak, Montgomery County official says

Updated links: I had missed seeing:

Ricki Lewis Like a Game of Clue, Genomics Tracks Outbreak, Revealing Evolution in Action and

Eli Perencevich Not a failure, a lesson. The NIH Clinical Center KPC Outbreak

There has been much needed and interesting discussion since I posted yesterday. As a practicing Infectious Disease physician regularly confronted by caring for patients ill with multi-resistant organisms, two articles particularly resonated–that of Dr. Perencevich, above, and Maryn McKenna’s The ‘NIH Superbug’: This is Happening Every Day. Her title captures the key point and of much of what had been troubling me;  that this is all too common an occurrence. As she notes:

“If I had to distill what bothers me most about what I read this week, it is that much of the coverage was either a villain story (hospital permits deadly infection!) or a hero story (genomic detectives save the day!) But in fact, the story of CRKP is neither. It is a story of systems breaking down. As a topic, systems are deeply undramatic. But unless we start paying more attention to systems — for research funding, for disease surveillance, for drug development; for addressing, in an organized way, the accelerating loss of the antibiotic miracle — the result will be deeply dramatic: more outbreaks, and more deaths.”

Hopefully, because the focus of these concerns is on the prominent NIH, there will be ongoing discussion of the conditions that lead to the development of these resistant “superbugs” now, and perhaps progress on all these fronts.

Credits:

Molecules to Medicine banner © Michelle Banks

Klebsiella pneumonia isolate image: CDC via Wikipedia

Judy Stone About the Author: Judy Stone, MD is an infectious disease specialist, experienced in conducting clinical research. She is the author of Conducting Clinical Research, the essential guide to the topic. She survived 25 years in solo practice in rural Cumberland, Maryland, and is now broadening her horizons. She particularly loves writing about ethical issues, and tilting at windmills in her advocacy for social justice. As part of her overall desire to save the world when she grows up, she has become especially interested in neglected tropical diseases. When not slaving over hot patients, she can be found playing with photography, friends’ dogs, or in her garden. Follow on Twitter @drjudystone or on her website. Follow on Twitter @drjudystone.

The views expressed are those of the author and are not necessarily those of Scientific American.





Rights & Permissions

Comments 4 Comments

Add Comment
  1. 1. lamorpa 3:31 pm 08/24/2012

    My grandmother lived independently for 91 years (with ever increasing frailty). One winter when she got the flu and was in the hospital semi-comatose, the doctor quietly offered 2 paths to my dad (her son): 1) Medicate her to the max and get her to survive the illness, though she would never recover enough to be fully conscious and live independently (it was her life’s wish to never go to a nursing home), or 2) ‘accidentally’ not prescribe antibiotics for a couple of days in which time she would reach a point of no return (the antibiotics were later prescribed to cover any malpractice inquiries). Our family knew the doctor for over 30 years and my father took the responsibility for this very weighty decision. The latter choice was made and things proceeded peacefully, sensibly, and economically (though this last condition was not a deciding factor). He’s never felt perfectly satisfied with the decision, but made a tough choice in a tough situation. I certainly hope someone is around to make that sensible choice for me.

    Link to this
  2. 2. Emiliano 11:23 pm 08/24/2012

    I salute your father, sir, and yourself, for your last comment. I have been invalided to a wheelchair since 2004, am a longtime (26 years) rheumatoid diseases sufferer, and since I can no longer exercise like I’d like to, the ol’ ticker is showing its ass, also. Frankly, sometimes I think I’d just like to not wake up some morning. I’m a burden, in varying extents, upon everyone around me. I sure hope someone will be kind enough to me and my friends and loved ones, to just let me go when the time comes that I can no longer contribute to anyone’s life, mine included.

    Link to this
  3. 3. Judy Stone in reply to Judy Stone 7:54 pm 08/25/2012

    Thank you and lamorpha for your thoughtful posts. This is a difficult and painful decision for many of us, and I applaud your thoughtful approach.
    Because of the changes in the public’s attitude and expectations, we can no longer act as lamorpha’s family doc–and I–and many others did. There are too many liability concerns as well as accusations of euthanasia. Also, unfortunately, the family physician is often no longer a part of the health care team when a patient is hospitalized. Care is increasingly turned over to hospitalists who work shifts and are unfamiliar with the patient and family, as well as to specialists.

    It is telling that many nurses and physicians, with gallows humor, joke that they have “Do not resuscitate” tattooed across their chest. I am haunted by what we do to patients, rather than for them now, and that we are increasingly being reduced to being technicians rather than caring engaged physicians…

    You might find this recent article of interest, as well:In Ill Doctor, a Surprise Reflection of Who Picks Assisted Suicide

    Thank you both for sharing your thoughts.

    Link to this
  4. 4. tipuasher 7:51 am 09/4/2012

    The message is that news does not stand on its own feet, the public expects to be terrorized. But here lies the irony, a bacteria that lives in your gut, can be spread by poor hygiene, not washing your hands and is expectantly resistant to all antibiotics since it lives in people. It’s a real life terror story.

    Link to this

Add a Comment
You must sign in or register as a ScientificAmerican.com member to submit a comment.

More from Scientific American

Scientific American Back To School

Back to School Sale!

12 Digital Issues + 4 Years of Archive Access just $19.99

Order Now >

X

Email this Article



This function is currently unavailable

X