A couple of weeks ago, after I posted about a very serious emerging bacterial threat, KPC, I received an email from a reader with an elderly relative in the hospital with a very serious case of pneumonia caused by KPC. What he* told me is shocking.
The relative, who has had repeated hospital stays and a previous MRSA infection, was in the hospital for a week before any laboratory cultures were performed. That’s right, a patient with practically every major risk factor for a multidrug resistant infection wasn’t tested for a week. So this patient wasn’t isolated, exposing other ICU patients and staff** for seven days. If there were ever a poster child for immediate laboratory tests and pre-emptive isolation, this patient would be it. Millions of your tax dollars have been spent trying to figure who is most likely to enter a hospital with a multidrug infection. How’s about someone fucking listen?
It gets worse: the primary physician has essentially decided this patient is a lost cause, so instead of administering colistin and tigecycline combination therapy, which usually works, the doctor treating with amoxicillin/sulbactam even though that most likely will not work. This is foolish for two reasons. First, the patient, even while dying, is still a carrier. Treatment will prevent the spread to the staff and visitors. Second, all of the non-target bacteria–many of which can cause disease–will be exposed to amoxicillin/sulbactam, selecting for bacteria resistant to those drugs (and most likely to other drugs of clinical importance).
At some point, people are going to become really pissed off and start suing over antibiotic misuse. And they’ll win. If hospital administrators, doctors, and nurses don’t deal with this voluntarily, the courts will force them to do so. There’s one thing I’m certain of: judges will be awful at practicing medicine and developing public health strategies.
*I’m keeping the case anonymous, so don’t read anything into the gender of the letter writer or the patient. Don’t blame the blogga, blame the patriarchy.
**The staff aren’t at risk for illness; however, they can act as carriers. KPC isn’t some mystical substance in the ether, it is a biological agent that has to be transmitted.