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 The White House on Friday told the U.S. Centers for Disease Control
and Prevention to slash rates of infections from
antibiotic-resistant bacteria by 2020 as part of a plan to prevent
patient deaths and curb overuse of antibiotics administered to
humans and animals.
The CDC is pointing to the success of the Chicago Prevention
Epicenter, one of five such CDC-funded programs nationally that
coordinate research between local scientists and public health
officials. The Chicago study focused on four long-term acute care
hospitals, which tend to have above average rates of carbapenem-resistant
Enterobacteriaceae, or CRE, called a "nightmare bacteria" because
even the strongest antibiotics fail to subdue it.
"When it comes to antimicrobial resistance, for many of the threats
that we face, we know what to do,” CDC Director Dr. Tom Frieden told
Reuters in an interview. "We just need to get it done."
The program involved testing all patients for CRE infections at the
time of admission and again two weeks later. Patients who developed
CRE were isolated in a private room or in a ward with other CRE-infected
patients. Healthcare workers wore protective gowns while tending to
them, using some of the procedures used when caring for patients
with Ebola. All infected patients were bathed in chlorhexidine
gluconate, an antiseptic commonly used in hospitals.
At the end of three years, cases of CRE infections fell by half, Dr.
Michael Lin, an infectious disease expert at Rush University Medical
Center in Chicago, told Reuters.
Lin said the exact protocol might not be suitable for the average
U.S. hospital, but shows how a focused strategy can help the CDC
reach its goals.
The World Health Organization has declared antibiotic resistance a
global emergency. In the United States, it causes 2 million serious
infections and 23,000 deaths each year, according to CDC estimates
that some health experts consider conservative.
Many of these infections occur in hospitals. CDC estimates that at
any given time, one in 20 hospital patients has an infection
resulting from medical treatment.
The agency plans to work with hospitals and health departments
across the country to develop surveillance programs to monitor and
reduce infections and to promote “antibiotic stewardship” programs
to stem over-prescription of antibiotics.
While the CDC has no regulatory authority, the government’s Medicare
and Medicaid health insurance programs require all participating
hospitals to develop a stewardship strategy within three years.
Failure to do so would disqualify them from the health plans.
In January, President Barack Obama's administration proposed
doubling the government's spending on tackling antibiotic resistance
to $1.2 billion. Obama said on Friday that the new superbug plan
“spells out exactly where the money would go.”
TALL ORDER
The president's plan for the CDC calls for a 60 percent reduction in
CRE infections by the end of this decade and halving infections
caused by clostridium difficile, a deadly diarrheal bug, as well as
life threatening bloodstream infections caused by methicillin-resistant
Staphylococcus aureus or MRSA.
The agency also wants to address the over prescribing and overuse of
antibiotics, which allow microbes to develop resistance to drugs, in
a more organized way.
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Many states, however, do not collect data on drug-resistant
infections. A 2013 poll by the Association of State and Territorial
Health Officials found that just half of 34 states that responded
collected surveillance data related to antimicrobial resistance.
Only 12 percent received state funding to do so. As part of his
budget request for 2016, Frieden wants to support surveillance
programs in each state.
CDC also wants to encourage more hospitals and health systems to
feed data on antibiotic prescription patterns to its national
database.
The CDC collects data from 5,000 U.S. hospitals on drug-resistant
infections, but only 70 use a program that feeds their data on
prescriptions to the agency, said Dan Pollock, chief of the CDC's
surveillance branch. The agency wants to help more hospitals connect
with the national database.
"We've got a long way to go," Pollock said.
CULTURAL RESISTANCE
More than half of all hospitalized patients will get an antibiotic
at some point during their stay, but studies have shown that 30 to
50 percent of antibiotics prescribed in hospitals are unnecessary or
incorrect, contributing to antibiotic resistance.
Recognizing that much of the misuse of antibiotics occurs outside of
hospitals, the White House plan gives doctors who take part in
Medicare or Medicaid three years to start reporting their
antibiotics prescriptions, with financial incentives and penalties
attached.
Turning that tide can take significant resources and meet with
resistance from doctors, experts said.
"It’s not a simple thing to do," said Dr. B. Joseph Guglielmo, dean
of the school of pharmacy at the University of California, San
Francisco. Patients often see antibiotics as an essential part of
their treatment and doctors weigh that against potential harm they
may cause in the future.
California already requires hospitals to have programs that
typically include continuous review of what antibiotics each patient
is receiving and designate experts consulting with the primary care
team about whether they can be discontinued.
Making such programs part of national health insurance requirements
will encourage others to follow, said Dr. Kavita Trivedi of Stanford
University School of Medicine and a spokeswoman for the Society for
Healthcare Epidemiology of America.
"You can be sure that if (Medicare) requires it, hospitals will find
a way to fund antibiotic stewardship programs, just as those in
California did.”
(Editing by Michele Gershberg and Tomasz Janowski)
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