United States is careless — in tracking deaths due to bacterial antibiotic resistance — a Reuters investigative report

© 2016 Peter Free

 

13 September 2016

 

 

Introduction — somebody dropped the Sense of Proportion Ball

 

As readers of this website know, I dislike avoidable stupidity. We are immersed in it by sky-full every day.

 

Reuters exposed a telling example of the "how dumb can one get" phenomenon last week. The news agency reported on the slovenly approach the United States has taken in dealing with increasingly antibiotic-resistant bacteria.

 

If you are easily scared, do not read what follows. Unlike terrorism, this problem probably really will kill someone you know.

 

 

Predictably, a super-superbug showed up on American shores recently

 

Nasty antibiotic-resistant superbugs have been hanging around the United States for more than 4 years. We're talking the kind that laugh at antibiotics.

 

For example, the metallo-beta-lactamase NDM-1 enzyme-producing gene was first identified in 2008. The resistance gene had probably traveling around in India or Pakistan since 2007. NDM-1 came to the United States between 2010 and 2012, depending upon which medical report one reads.

 

The name (NDM-1) refers to a gene that gives the bacteria containing it resistance to carbapenem antibiotics. This group of antibiotics are most frequently used against multidrug resistant bacteria. They are last resort drugs. Losing their effectiveness is bad.

 

In May 2016, we were informed that a Godzilla bug (my term) had (also predictably) arrived:

 

 

A dangerous new form of antibiotic resistance has spread to the United States, according to a report published Thursday.

 

Researchers at the Department of Defense announced that a Pennsylvania woman developed a urinary tract infection (UTI) with bacteria that fought off an antibiotic of last resort called colistin, and had 15 genes for resistance to other antibiotics.

 

Until now, many bacteria have been vulnerable to colistin, even if they have been able to survive other medications.

 

Since this type of resistance can easily spread between bacteria, the findings have sounded alarm bells among scientists over fears that common infections will soon be untreatable.

 

© 2016 Melinda Wenner, Dangerous New Antibiotic-Resistant Bacteria Reach U.S., Scientific American (27 May 2016) (see the journal report that this is based on here)

 

 

Lena H. Sun and Brady Dennis, writing for The Washington Post, accurately synopsized the meaning of this development:

 

 

For the first time, researchers have found a person in the United States carrying bacteria resistant to antibiotics of last resort, an alarming development that the top U.S. public health official says could mean “the end of the road” for antibiotics.

 

© 2016  Lena H. Sun and Brady Dennis, The superbug that doctors have been dreading just reached the U.S., Washington Post (27 May 2016)

 

 

Now the double eyebrow raise

 

With an advance notice of many decades, one would think that we would have been preparing. Even when I was studying medicine some 23 years ago, we were concerned about losing antibacterial drugs' effectiveness.

 

Yet, since that time, even the basics of dealing with antimicrobial resistance have not been addressed.

 

For instance, in order to know the extent of a problem, one needs to track and type it. Incredibly, the United States is not even been attempting to keep tabs on the number of deaths caused by drug-resistant organisms:

 

 

Twenty-four states and the District of Columbia – an area comprising 3 of every 5 Americans – said they do not regularly track deaths due to antibiotic-resistant infections.

 

In contrast, all 50 states require reporting of AIDS-related deaths. Deaths from hepatitis C and tuberculosis are also closely tracked.

 

A Reuters analysis of death certificates found that nationwide, drug-resistant infections were mentioned as contributing to or causing the deaths of more than 180,000 people during the same [12 year] period.

 

Connecticut, with a grant from the CDC [Centers for Disease Control], is the only state that closely monitors MRSA [methicillin-resistant Staphylococcus aureus] deaths.

 

It logged 2,084 deaths from drug-resistant infections from 2003 to 2014, all but 10 from MRSA. That’s nearly twice the number of deaths from MRSA in the state that Reuters found in its death certificate analysis.

 

[In other words, when one actually looks for them — resistant bacteria cause more deaths than death certificates record.]

 

But as Reuters found, surveillance carried out by the states can come up against strong institutional resistance and laws that shield the healthcare industry.

 

[You can intuit how this works — If I admit that my clinic or hospital has nasty critters lying around, y'all won't bring me patients. And if word gets out that I was incompetent in dealing with these resistant bacteria, then you will sue me. What is an illness profiteer to do?]

 

© 2016 Ryan McNeill, Deborah J. Nelson, and Yasmeen Abutaleb, ‘Superbug’ scourge spreads as U.S. fails to track rising human toll, Reuters Investigates (07 September 2016) (excerpts) (my comments in italics and brackets)

 

 

And here is the really idiotic thing

 

Even if we tracked resistance data, we could not put the results into our tracking systems.

 

Reuters discovered that:

 

 

[E]ven when they are recorded, NCHS [National Center for Health Statistics] can’t feed that information into vital statistics:

 

The World Health Organization (WHO) classification system the agency uses lacks mortality codes for most drug-resistant infections, though it has codes for more than 8,000 other possible causes of death.

 

The CDC [Centers for Disease Control] added codes for use in the United States for terrorism-related deaths a year after the Sept. 11, 2001, attacks. It could do the same for deaths from drug-resistant infections.

 

Officials told Reuters the CDC is instead working to incorporate the codes into the WHO’s next revision of the international classification system.

 

The revised system is expected to be completed in 2018 but not fully in use until the 2020s.

 

© 2016 Ryan McNeill, Deborah J. Nelson, and Yasmeen Abutaleb, ‘Superbug’ scourge spreads as U.S. fails to track rising human toll, Reuters Investigates (07 September 2016) (excerpts)

 

 

How's that for lollygagging a critical timeline?

 

The resistance problem has been around since the invention of penicillin. It gained noticeable momentum in the mid-1990s. But despite innumerable forewarnings, we are still talking about waiting until the 2020s to:

 

 

(a) implement the codes

 

(b) that will track drug resistance death data

 

 that

 

(c) we have not yet created a system to gather,

 

(d) much less enforce.

 

 

For empahsis, by the mid-2020s we will have classification codes to identify data that we do not have and are not enforceably required to get.

 

 

The moral? — A sense of proper proportion matters

 

Contrast:

 

 

(i) the trillions of dollars and institutional edifices that the United States has invested in the "war" against terrorism

 

— against —

 

(ii) the vanishingly small amount of effort that we have aimed against a much deadlier and massively more debilitating problem.

 

 

Evidently, evolution has not properly prepared our inadequately brained species to gracefully survive the challenges of living on a biological Earth.

 

To emphasize this last point, the US Department of Agriculture continues to do its best to enthusiastically exacerbate the continuing rise of multidrug resistant bacterial numbers and strength.

 

OMG.