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.