The Centers for Disease Control and Prevention is warning that illnesses and deaths from antibiotic resistance will rise in the US unless specific changes are made in the US public health system—and coupling the prediction with a blunt challenge to Congress to give it the money it needs to make the changes happen.
In a new report, published Tuesday afternoon, the CDC estimates that infections caused within healthcare institutions by the most problematic superbugs will rise by 10 percent over the next five years, from 310,000 to 340,000. (Those infections are a subset of the 2 million antibiotic-resistant infections that the CDC estimates occur each year in the United States.) That rise could be reversed, the agency said, if healthcare institutions could identify patients who carry dangerous bacteria with them as they check in and out of acute care hospitals, long-term care and rehab, and work together to keep their infections from being transported from one place to another.
The rest of the CDC’s report describes computer models that explore how coordination among hospitals, nursing homes and long-term care facilities could keep those infections from cycling among institutions. I’ll get to that in a minute. But in launching the report, the agency’s director Dr. Thomas Frieden was unusually direct about the need for money to make the interventions happen.
“We’ve requested funds in the fiscal year ’16 ‘Antibiotic Solutions Initiative’ to fund state protection programs in all 50 states and ten large cities to do this work,” Frieden said at an afternoon press briefing. “Without those investments, we’ll continue to struggle, and patients will continue to get infections that could have been prevented… It’s up to Congress to support the resources needed to protect Americans.”
It’s not common for agency heads to make their lobbying for funding quite so public. That Frieden did may represent exasperation with how the CDC’s proposed budget has fared in negotiations. The agency asked for $264.3 million to combat antibiotic resistance (detailed at the bottom of the first page of this budget request), in line with the commitment to reducing superbugs that the Obama administration expressed when it launched the National Strategy for Combating Antibiotic-Resistant Bacteria last year and hosted a “forum on antibiotic stewardship” in June.
That White House backing carried no weight in Congress, though. The House Appropriations Committee approved less than half the CDC request, $120 million, and the Senate side only $30 million. (The numbers were collated by the Council of State and Territorial Epidemiologists, a public health trade group.)
The jockeying over money is critical to the CDC’s new superbugs prediction because of what the models indicate is needed to keep hospital infections down: not just improving infection prevention inside health care facilities, but sharing information on patients’ infections with other facilities in the same region, using the local or state health department as a data broker. That implies hiring additional personnel to do infection-control and lab work in hospitals and long-term care, and also to collect, monitor and distribute data in the health department. All of which would cost money.
The problem of patients carrying infections between hospitals and nursing homes is well-known, and stubborn to solve. In 2010, researchers in Michigan studied the traffic between a 4-hospital network that was struggling with rising rates of one highly resistant infection, Acinetobacter, and the facilities that sent patients to those hospitals and and received patients back from them. (Here’s the study and an editorial examining it.) They documented that the patients were becoming infected in the long-term care facilities, carrying the superbug into the hospital, becoming a source of spread there, and then carrying it with them to different facilities—only half of the patients returned to the nursing home they came from.
“Resources are not where they need to be in every facility,” Dr. John Jernigan, the lead author of the CDC report, told me by phone. “Long-term care facilities in general don’t have the same infection-control resources that acute care does.” The plan underlying the CDC models would shore up the weak links in the chain, making the relationships among US healthcare facilities more like those in Europe, where superbugs are actively tracked and data is shared regionally or nationally.
If US healthcare had similar programs, the CDC estimates, hospital infections just with those four pathogens could be reduced by more than 600,000 illnesses and 37,000 deaths over 5 years. Working with academic modelers, the agency examined the effect of identifying infections and sharing data on two sizes of healthcare networks, one involving six nursing homes feeding four hospitals, and another with 74 nursing homes feeding 23 hospitals and five long-term acute care facilities. In the smaller network, they found that hospital infections would be reduced by 74 percent over 5 years; in the larger one, using a different model, the reduction was 55 percent over 15 years.
There are some places in the US where efforts such as the CDC outlined are already occurring. Illinois, for instance, maintains a registry of patients who have been diagnosed with CRE, one category of superbug; facilities can check their new patients against it, to know whether to whomp up precautions. South Dakota talks to neighbor states to check patient traffic across its borders. But to extend protections like that nationwide, “we need additional investment,” Jernigan told me. “Not all health departments will be able to implement this without additional resources.”