Mike the Mad Biologist

I’ve been looking at the House and Senate Bills, and, on antibiotic resistance, they’re not bad. Both bills would evaluate hospitals on hospital-acquired infection rates (although there’s no mention of nursing homes, which are a significant focus of infection). This is good.

The House bill focuses primarily on reporting of hospital-acquired infections. It’s actually very specific, and there’s an entire section dedicated to it (starting at p. 913). Hospitals would be penalized if they fail to report. Infections (and pertinent information, which includes resistance) would be publicly available and also broken down by demographic factors. The latter is really important, as hospitals traditionally have been reluctant to report these statistics since infection rates and resistance are strongly dependent on patient population (e.g., the elderly and the indigent are far more likely to have MRSA than the rest of the population). The House bill also specifies reducing healthcare associated infections as a high research priority–in fact, it’s the first item (p. 1329). Also note the use of “health care associated infections”: this could be interpreted to mean infections outside of hospitals, such as nursing homes.

(Tangential aside: The research in both bills is very focused on infection reduction and medical outcomes, not basic biological research.)

The Senate bill, while viewing reporting as an assessment of quality, isn’t quite as strong. Infectious disease surveillance is viewed as a quality metric more than as a specific problem. What is interesting is that, regarding research to improve outcomes, one area is (p. 1059):

(ii) practical methods for addressing health care associated infections, including Methicillin-Resistant Staphylococcus Aureus [MRSA] and Vancomycin-Resistant Entercoccus [VRE] infections and other emerging infections

Leaving aside the incorrect capitalization of “aureus”*, it looks like MRSA and VRE are going to receive a lot of attention. Clearly, somebody scared the shit (and snot) out of a couple of senators. This isn’t a bad thing: MRSA kills more people than AIDS/HIV in the U.S. If MRSA became vancomycin-resistant, we would be in a lot of trouble. But I hope this doesn’t crowd out attention to other emerging problems like carbapenamase resistant organisms (KPC) and the larger problem of extended-spectrum beta-lactamases, which are genes that confer resistance to most drugs derived from penicillin** (KPC is just the worst case).

This isn’t bad, although the details, much of which will be regulatory in nature, will really matter. I would also like to see more about dedicated sources of funding for both enforcement and surveillance of infectious disease. I’m also worried that each of the unique parts of the House and Senate bills will be stripped out in conference.

Nonetheless, it’s better than what we have now.

*Only Staphylococcus should be capitalized.

**ESBL-bearing organisms are usually resistant to other classes of drugs too.

Comments

  1. #1 WcT
    November 23, 2009

    Is it really an “if” MRSA becomes vancomycin resistant? Weren’t there a couple of cases of VRSA in a hospital in Detroit in the last couple of years?

  2. #2 Gingerbaker
    November 23, 2009

    I’ve often wondered why someone who had a relative die from a nosocomial MRSA didn’t sue the hospital for negligence.

    I think the usual pleas that the hospitals were doing all they could possibly do would wither under a cross examination:

    What structural improvements have been made over the past ten years to hospital rooms to accommodate chemical sterilization procedures. What – none?

    How often is each room, hall way, bed, sink etc completely chemically decontaminated? What – almost never?

    Are physicians still allowed to wear neckties in your hospital? They are? Then surely they are required (and monitored) to wash their hands between each patient, and to don new autoclaved robes for same? No – they are not?

    Do you still want to insist that you were not negligent?

    The fact is that there is a LOT of decontamination procedures that hospitals could be doing but don’t- they simply immediately go to aminoglycoside antibiotics.

    They deserve every lawsuit they get.

  3. #3 llewelly
    November 23, 2009

    Neckties!?!? In a hospital? What clueless moron allowed that?

  4. #4 tmullins
    November 23, 2009

    I’ve been asking questions for over five years and no one can do anything. http://www.wisecountyissues.com/?p=62

  5. #5 Mike the Mad Biologist
    November 23, 2009

    WcT,

    You’re right that there have been isolated cases of VMRSA, but these have evolved within a patient and not spread from patient to patient–the latter is what I’m worried about. If there’s an ‘advantage’ to VMRSA, it’s that these evolve in patients who, typically are already isolated, so the chance of spread is very low (although not zero).

  6. #6 video
    November 30, 2009

    On some less-detailed maps their layout looks similar except they’re inverted relative to one another and there isn’t always a sign telling you you’ve crossed the border from one to the other. I once was using a map to navigate in that area thinking I was in Quincy only to notice that the setting sun was on the wrong side of the car.

  7. #7 sikiƟ izle
    November 30, 2009

    On some less-detailed maps their layout looks similar except they’re inverted relative to one another and there isn’t always a sign telling you you’ve crossed the border from one to the other. I once was using a map to navigate.

  8. #8 Dave
    November 30, 2009

    MRSA is a relatively small part of the problem. IMO, you are right to worry much more about ESBLs, KPC, etc. etc. with the Gram-negs. Recent BMJ editorial commentary revealed that 5-year success with 50% reduction in MRSA in London hospitals failed to affect the worse bugs — “substantial” increase in total hospital infections in the same period. The two US societies for infection control professionals issued a joint policy statement REJECTING the legislative approach for MRSA screening. Starves cheaper, more effective means from scarce funds without comparable benefit. History strongly suggests that any bill that becomes law will follow similarly ill lines. The whole thing should be deleted and started over. This time with guidance by people who actually understand the problem, not congressional staffers.