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Wed April 2, 2014
The Crisis Of Antibiotic Resistance: The Germs Are Winning
An estimated 23,000 people die each year in the U.S. from infections that don’t respond to antibiotics.
Pamela Woodbury lives in a two-story house in Spencer, Mass. Three years ago, Woodbury was on her way to work when she took a spill on her steps and broke her ankle. She says she not doesn't have any mobility in her ankle.
"It was a closed break. There was no skin broken, no blood, nothing. My ankle was in an L position. The leg went one way and the ankle went the other way," she said.
Surgeons at UMass Medical Center in Worcester needed nine screws and a metal plate to fix the break. But when the doctor took the cast off, he didn’t like what he saw.
"It was orange. The fluid was a clear orange fluid that kept… It was really coming, you know, really dripping out," Woodbury said.
Woodbury’s wound had become infected. About one in every 25 hospitalized patients gets an infection from medical care, according to the Centers for Disease Control and Prevention. Antibiotics are often an effective treatment, but increasingly, some infections are antibiotic resistant, and can lead to serious illness and death. That’s why some hospitals in Boston are actively trying to curb infections, and prevent antibiotic resistance.
Surgeon David Mattingly is the chief of joint reconstruction at New England Baptist Hospital in Boston, which has infection rates consistently lower than expected. In 2011, the Baptist had only 14 knee or hip replacement infections, a third less than predicted by the Massachusetts Department of Public Health.
Mattingly attributes New England Baptist’s low infection rates partly to the fact that the hospital specializes in orthopedic care and not the treatment of other complicated health conditions. But he also says preventing infection happens at every stage of patient care and starts days before surgery.
"It kinda begins in the office, when you meet patients. It’s important to identify patients that are at high risk for infection and try to solve any of their problems, prior to surgery," he said.
What this means for patients at New England Baptist is an extensive prescreening before surgery to identify risk factors for infection, such as having unresolved dental problems, or diabetes.
Robert Watkins from Dover, New Hampshire is getting a total left hip replacement at New England Baptist. In addition to testing his blood for signs of infection, he gets a nasal swab to see if he is a staph bacteria or MRSA carrier. MRSA is a very serious infection that is resistant to most antibiotics. Watkins also is given a special cleanser.
"I’ve been given this cleanser that I have to wash the surgical area with three days prior to coming into surgery," Watkins said.
If the nasal culture comes back positive for MRSA, Watkins will be given a drug called Vancomycin to prevent an infection. But increasingly, there’s a strain of MRSA that is resistant to even that powerful antibiotic. In the United States, the CDC estimates that every year at least two million people acquire a drug resistant infection.
And so, it’s not just that people are getting infections from medical care, it’s that those infections are increasingly hard to treat.
Helen Boucher is an infectious disease doctor at Tufts Medical Center in Boston. She says antibiotics are over prescribed, and new antibiotics are rarely developed, leading to a crisis situation.
"The crisis is the crisis of antibiotic resistance," she said.
If antibiotic resistance isn’t curbed, Boucher said there could come a point when doctors can no longer do medical procedures now considered routine, like total hip replacements, or treatment for cancer. This is because people who undergo those treatments are prone to infection. If the risk of drug resistant infection becomes too great, then routine treatments would no longer be safe.
"We support everybody who gets chemotherapy with antibiotics when their cells fall down. We support patients who get organ transplants with antibiotics and get a joint replacement all these things we take for granted in the Untied States, may become prohibitive if we can’t control this problem," Boucher said.
One way Tufts is working to control this problem is to carefully monitor antibiotic use through what’s called an antimicrobial stewardship program.
"Antimicrobial stewardship is about using the right antibiotic in the right patient at the right dose at the right time," she said.
At Tufts, certain powerful antibiotics require the approval of a small team of experts. The effort is an attempt to prevent their overuse so that they’ll still work when they are needed.
But Betsy McCaughey, founder of the organization Reduce Infection Deaths, said the best solution is even simpler than that.
"While I agree that antibiotic stewardship is important, it is not the immediate answer …in the case of hospital infection, the number one issue is hygiene," McCaughey said.
But McCaughey said hand washing alone isn’t enough, because clinicians’ hands can become contaminated quickly:
"Seconds after they’re cleaned as soon as they reach up and pull open the privacy curtain to see the next patient, or walk into the room and put their hands on the bed rail, or touch or open a drawer. In other words, as long as the surfaces in the hospital are inadequately cleaned, hand hygiene is inadequate; it’s necessary but not sufficient," McCaughey said.
Sufficient infection prevention remains a work-in-progress. No one knows this more than patients who’ve suffered from hospital acquired infections. Patients like Pam Woodbury, the Spencer, woman whose broken ankle became infected after surgery.
Woodbury’s infection proved resistant to antibiotics. She needed a second surgery to clean the wound and was hospitalized for eight days before the infection cleared.
"I started thinking to myself, how many people go through this?"
Unfortunately, a lot – according to the CDC, more than 700,000 people each year.