In the past, resistant pathogens spread mainly in hospitals. But today an especially virulent strain of MRSA has emerged outside of hospitals, making infection control even tougher.
Every hospital in the country has a policy for handling MRSA, but we have failed dismally in getting a handle on it, says Montefiore Medical Center's Currie. A lot of the guidance on infection control is not data-based.
The University of Maryland's medical center now screens everyone checking into its nine intensive-care units for MRSA, whether the patient shows signs of infection or not. There's debate in the United States over whether [such] 'active surveillance' works, says medical director Standiford. I believe it does and that it saves money in the long run by identifying the reservoirs of infection non-symptomatic patients who can spread the bug. Every time you get MRSA in the bloodstream, it costs the hospital $20,000 at least because the patient's stay is so much longer.
In hospitals, the confining of infected patients once halted the spread of contagion, but with the number of infections growing, many hospitals don't have enough separate areas to confine patients, says Allison Aiello, an assistant professor of epidemiology at the University of Michigan School of Public Health.
And with the new, highly virulent strain of MRSA popping up in the community, infection control becomes even harder. More patients already have a resistant infection when they enter a hospital, and no one knows how the CA-MRSA strain spreads, says Robert Daum, a professor of pediatrics at the University of Chicago.
During the past decade, the federal government has taken stabs at attacking the antimicrobial-resistance problem but hasn't sustained its support. In 1999 the CDC established a Federal Interagency Task Force to Combat Microbial Resistance, which issued an action plan in 2001. The inadequately funded panel, however, has the tools to do little but issue an annual laundry list of uncoordinated activities, says Guidos of the Infectious Disease Society of America.
In 2000, Sen. Edward M. Kennedy, D-Mass., and former Sen. Majority Leader Bill Frist, R-Tenn., a cardiac surgeon, authorized $40 million in annual funding for resistance research and federal initiatives like the task force. But Congress never appropriated any funds, says Guidos. In 2001, for example, then-Rep. Sherrod Brown, D-Ohio now a senator and Sen. Orrin Hatch, R-Utah, sponsored legislation to fund the programs, but no funding ever came, Guidos says.
Moreover, jurisdictional struggles between the CDC and the states makes surveillance of resistance difficult, says Feldgarden at the Alliance for the Prudent Use of Antibiotics. Too often, there's a one-way highway for information. It goes up to the CDC and then doesn't get back to the states, he says. And states don't always hold up their end of the reporting bargain, he adds. Unless they get money, states don't want to play nice with the CDC.
The CDC and state public-health agencies already issue many disease-surveillance reports, and diseases don't go away. So if you want to add something such as resistance you need to add money, Feldgarden explains. But in recent years states haven't been adding money for public health.
It's ridiculous that CVS [pharmacy] knows more about the [birthday] cards I send to my mother than health agencies know about developing infectious outbreaks, says Feldgarden. Real-time reporting is essential, because once you're beyond the anecdote stage, look out.
