Allen County and Indiana health care officials are witnessing firsthand the social and economic costs of fighting an escalating war against a variety of deadly and drug-resistant super bugs.
A multidrug-resistant strain of tuberculosis contracted by a Fort Wayne teen three years ago ended up costing taxpayers nearly $100,000 for two years of treatment.
One local doctor has witnessed a handful of people currently hospitalized with potentially fatal infections.
The first American diagnosed with MERS – a mysterious virus from the Mideast where the man is a health care worker – was hospitalized in northwest Indiana last month.
Local hospitals have armed themselves with new equipment to quickly find and treat patients infected with the drug-resistant organisms.
Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die as a direct result of these infections, while many more die from other complications of antibiotic-resistant infections, according to the U.S. Centers for Disease Control and Prevention.
It’s horribly, horribly devastating, especially to see a young person die and have nothing left to treat them with, said Dr. Scott Stienecker, medical director of epidemiology and infection prevention and director of infectious disease services at Parkview Health. It’s far worse elsewhere in the U.S., but it’s coming our way.
Stienecker has seen a significant number of resistant organisms, he said. There are less than 10 different patients with the infections, but I feel that each one is a very high risk.
MRSA, a drug-resistant staph infection, can be found in hospitals but is also affecting a growing number of people in the community, including healthy athletes and children, the CDC reports. In Indiana, most cases originate in correctional facilities and competitive sports teams in high schools and colleges, according to the Indiana State Department of Health.
The drug-resistant organisms cause a variety of illnesses including pneumonia, bloodstream, wound and urinary tract infections. These infections fall into a group called KPC, and are caused by an organism that lives in the large bowel and have become resistant to a class of antibiotics called Carbapenems.
Anti-microbial resistance develops when a micro-organism – bacteria, fungus, virus or parasite – no longer responds to drug treatment. Many antibiotics widely used in the prevention and treatment of infectious diseases no longer work, making infections harder or impossible to control, increasing the risk of infection and resulting in higher death rates, according to a recent report from the World Health Organization.
The world has entered a post-antibiotic era in which common illnesses and minor injuries could kill people of all ages, the report said.
We are no longer fighting just a germ. We are fighting a piece of DNA that moves easily from one bacteria in our intestine to another, Stienecker said.
Organisms pick up the DNA with codes for antibiotic resistance and pass out of the bowel where they can be easily transmitted to others, he said.
The mutant bacteria can then infect a new person, even healthy people, who can die because it is resistant to all known antibiotics, Stienecker said. It’s far worse if it’s DNA-passed to otherwise healthy people, who suddenly drop dead.
Compounding the problem is the fact that no new classes of antibiotics have been developed by drug companies for 25 years.
It costs millions to develop and market a new antibiotic, Stienecker said. Drug companies prefer to spend research money on the next Lipitor or the next Zantac and not the next antibiotic which is given relatively infrequently with little overall return on an investment.
Officials say health professionals and consumers alike must be educated on the harmful effects of overprescribing antibiotics.
Antibiotic stewardship is extremely important in reducing the amount of bacterial resistance to antibiotics, said Dr. Deborah McMahan, Fort Wayne-Allen County health commissioner.
For years, some professionals have continued to prescribe antibiotics for ailments as simple as a common cold or for illnesses in which an antibiotic would have no effect. In addition, since antibiotics are given to livestock to fatten them up, consumers digest antibiotics through eating meat.
Some have pointed a finger at long-term exposure to antibacterial products, claiming agents such as triclosan (liquid soaps) and triclocarban (bar soaps) could cause bacterial resistance or hormonal effects such as disruption of the reproductive system.
To date, studies have shown that there is no added health benefit for consumers – not including health care professionals – using soaps containing antibacterial ingredients compared with using plain soap, according to the Centers for Disease Control and Prevention.
The situation requires immediate legislative intervention because astounding little federal attention has been given to the staggering problem, according to the CDC.
This will not change until society decides something must be done and changing the situation will require significant congressional willpower, Stienecker said.
The Strategies to Address Antimicrobial Resistance Act, reintroduced by Sen. Sherrod Brown, D-Ohio, is designed to strengthen the country’s response to infectious pathogens that are becoming increasingly resistant to existing antimicrobial drugs and remove antibiotics given routinely in animal feed to make them fatter and bigger, Stienecker said.
It’s difficult to get clear numbers on how many drug-resistant organisms are out there because many antimicrobial resistant organisms are not reportable, although outbreaks of any organism are reportable, said Kenneth Severson, spokesman for the Indiana State Department of Health.
Some organisms that can have significant antibiotic resistance – such as TB, N. gonorrhoeae and salmonella – are reportable, and we track those through our reportable surveillance system, Severson said. We also monitor and investigate outbreaks and clusters of non-reportable organisms.
The state is currently revising the communicable disease reporting rule to include mandatory submission of drug-resistant organisms to better track incidence of infections, he said.
McMahan thinks that’s a good idea.
The resistant Klebsiella and other resistant bacteria – commonly called CRE – are not yet reportable diseases, although this will likely change with the new reporting rule, McMahan said.
I think the numbers identified in the state are still low, but we do need to be prepared for an increase in cases over time, she said.
The drug-resistant infections are painful, difficult to treat and cost the health care system many billions of dollars every year to treat, according to the CDC.
Treatment for drug-resistant TB is especially expensive.
A recent CDC study found that direct costs for treatment – including drugs, diagnostics, case management and hospitalization – of multidrug resistant TB averaged $134,000 per case in 2010, compared with $17,000 to treat drug-susceptible TB, McMahan said.
The Fort Wayne high school student who contracted multiresistant TB in December 2011 was treated over two years with six medications and injections at a cost to the county of $80,000, said Mindy Waldron, department administrator at the Department of Health.
The student moved to another county toward the end of treatment and that county’s cost was an additional $16,000, she said.
The treatment was successful, Waldron said.