Antibiotic Resistance and National Healthcare

Revere has a very good historical roundup of the 'uninevitability' of a national or universal healthcare system. One consequence of our fragmented, patchwork healthcare system is antibiotic resistant bacteria.

Just to give you an example of how bad the antibiotic resistance problem is, in most hospitals, anywhere from 20-70% of Staphylococcus aureus infections are methicillin resistant ("MRSA"). In long-term care facilities, around 90% of S. aureus infections are MRSA. MRSA infections are quite serious. Not only are they harder to treat (due to treatment failure from using the wrong antibiotic, and because more expensive antibiotics have to be used), but they are often more virulent. The problem is so bad that some infectious disease specialists are only half-joking when they refer to MRSA as "standard of care."

One reason that antibiotic resistanct bacteria are out of control in the U.S. is our fragmented healthcare system externalizes the economic and medical costs of antibiotic resistance. Essentially, no one 'owns' the problem. In hospitals, it's far too expensive to screen and isolate patients who enter carrying antibiotic resistant bacteria (e.g., MRSA, VRE, Acinetobacter baumannii). Infected medical workers, who can act as Typhoid Marys, can't be sent home; unpaid leave would result in strikes, and hospitals don't want or can not afford to pay for workers who are on 'antibiotic resistance leave.'

Similar problems occur in the doctor's office. If you show up with a nasty, pustulent boil, two things will typically happen:

1. The doctor will lance and irrigate the boil. Most of the time, this would be sufficient by itself. However...
2. The doctor will prescribe an antibiotic without any laboratory work. In other words, the doctor does not know what species he or she is treatment, or whether that antibiotic will even work (i.e., the doctor does not know what the bacterium is resistant to).

Here too, the incentives are entirely economic. It is far cheaper to just give an antibiotic and send the patient on his way, than to run lab tests, and then either have a follow up visit (or phone call) followed by a prescription, if needed.

Contrast this to the Netherlands, which instituted a policy called "search and destroy" to control MRSA infections. Upon entrance to the hospital, every patient is screened for MRSA. Any patient who tests positive is isolated and treated for the infection. Any hospital worker who is a MRSA carrier is sent home on paid leave until the infection is gone. This policy has kept the frequency of MRSA infections to under one percent. Note that it's expensive and that the healthcare system has to make antibiotic resistance a medical priority.

Right now, the priority in healthcare is anything but antibiotic resistance...