It’s the biggest threat facing health care in the United States, according to the Centers for Disease Control and Prevention. It’s a problem that increases the severity of diseases, causes longer hospital stays and drives up health care costs.
“It” is antibiotic resistance.
The problem has reached such a level at the nation’s hospitals that the CDC, the Food and Drug Administration and several other national health organizations have launched campaigns to increase knowledge about when to use antibiotics, and how to use them as prescribed.
Colorado is no different. The state Department of Public Health and Environment created Get Smart Colorado two years ago to address the rising problem of antibiotic resistance bacteria.
“We focus on the general public and health care providers,” said Kelly Kast, program coordinator. “It’s an increasingly serious problem. Just think what will happen if bacteria become resistant to the usual antibiotics. People go into the hospital, have to take stronger antibiotics — which have some serious side effects — and could be sicker, longer. It could get very expensive.”
Colorado focuses on health care providers — not just the people who take the medication. Antibiotics can be over-prescribed, Kast said.
“Sometimes people come in and demand antibiotics,” she said. “And doctors, wanting that customer satisfaction, will prescribe it, even if it’s not necessary. Use as prescribed, that’s a problem, too. Some people don’t take all their medication, they stop taking it when they feel better, and that can lead to resistance as well.”
Dr. Bruce McHaffie, a local pediatrician, said he tries to teach parents about when their children need antibiotics — and when they don’t.
“Sometimes they try to insist,” he said. “But we just tell them that not all infections will respond to antibiotics.”
The health department tracks streptococcus pneumonia, the bacteria that cause common childhood ear infections. Before the 1990s, Kast said penicillin killed the bacteria, universally. Now, the bacteria are increasingly resistant, and other drugs must be used.
“And there aren’t a lot of new antibiotics being created by the drug companies,” Kast said. “The FDA and CDC are encouraging companies to experiment to create more, but there aren’t a lot coming out right now.”
McHaffie said that until a few years ago, drug-resistant ear infections were an increasing problem — with 30 percent of ear infections caused by bacteria that are resistant to drugs.
“But they came out with the pneumonia vaccine a few years ago,” he said. “And it’s less of a problem in Colorado than it was. Some places are still reporting 30 percent, 35 percent resistance.”
There is hope, he said. If doctors do not treat infections immediately with antibiotics, studies show that the antibiotics regain some of their effectiveness.
“So if you use them only when needed, they’re found to be more effective,” McHaffie said. “Even with bacteria that are becoming resistant, using them (antibiotics) less frequently is a way to maintain their effectiveness.”
About half the pharmaceutical companies in the United States left the antimicrobial field in the mid-1980s, according to the National Foundation for Infectious Diseases.
“Recently, they are returning in response to the need,” according to a white paper produced by the foundation. “Educational projects for physicians and patients should be emphasized. Antibiotic use must improve so as to preserve efficacy of the drugs we have. More research support is needed in order to define the molecular basis for resistance and to find ways to circumvent it. Better surveillance systems for antibiotic resistance are needed. Inter-action and interrelationships between surveillance groups, both in animal and human microbiology need to be established and solidified.”
Take antibiotics only as directed — those instructions are increasingly important, particularly during the cold and flu season, Kast said. Many people go to the doctor with sore throats, ear infections, sinus infections and colds caused by viruses, which do not respond to antibiotic treatment.
“Antibiotics do not work for all infections,” she said. “If you’re concerned, go to the doctor. But let the doctor decide what the treatment needs to be. Over-prescribing antibiotics is one of the leading factors of drug-resistant bacteria.”
Experts agree that the cost of antibiotic resistance is substantial, but estimates range from $100 million to $30 billion annually, according to the Center for Science in the Public Interest.
The National Foundation for Infectious Diseases estimates the cost to be $4 billion annually.
Those resistant infections are difficult and costly to treat, according to the Center for Science in the Public Interest.
For example, the cost of treating a patient with tuberculosis increases from $12,000 for a patient with a drug-susceptible strain to $180,000 for a patient with a multidrug-resistant strain.
Multidrug-resistant tuberculosis (MDR-TB) is a serious public-health threat worldwide. In the United States, MDR-TB was unheard of in the 1980s. However, the number of cases of drug-resistant tuberculosis has risen precipitously since the 1990s, the association says.
Resistant tuberculosis has never been found in El Paso County, said Lynn Baldvins, infection prevention program manager for Memorial Health System. But the hospital considers other drug-resistant bacteria to be a “huge problem,” she said.
“Methicillin-resistant staphylococcus aureus is a problem,” Baldvins said. “And we take very aggressive steps. It’s a concern because staphylococcus is ubiquitous, it’s everywhere on our skin, in the environment. And for it to be resistant to a pretty sophisticated antibiotic, that’s a concern.”
The cost of treating those drug-resistant infections is hard to determine, she said.
“I couldn’t begin to quantify it,” Baldvins said. “It’s hard to put a number on. The isolation costs are a big factor. It costs a lot of money to put people in isolation, and it takes longer to care for them. It takes longer for them to get well.”
Patients with drug-resistant bacterial infections — no matter what kind — are given special treatment at Memorial, she said.
They are flagged, so when they come in for treatment, doctors know they have a drug-resistant infection. When they are hospitalized, they are put in isolation.
“The hospital also has a very aggressive hand hygiene program,” she said. “Every doctor, nurse, volunteer who works with those patients must use good hand hygiene. It’s how the staphylococcus spreads — poor health care hygiene. So we insist on that, all over the hospital, actually.”
The biggest fear: the hospital might one day see a patient who does not respond to any antibiotic treatment.
“That’s the worst case, that’s what we’re afraid of,” Baldvins said. “We might have a situation where the patient has an infection, and we won’t be able to eliminate that infection.”