The United Nations General Assembly sounded the alarm last month on superbugs, antibiotic-resistant organisms that are cropping up with disturbing frequency around the world and rendering formerly tamed foes into new threats. Among them: a new strain of drug-resistant tuberculosis and an E.coli that’s impervious to the strongest medicine we’ve got. The bacteria that cause gonorrhea may soon be untreatable by all current antibiotics too.
It was only the fourth time in history that the General Assembly has focused on a health issue. That’s a sign of just how scary this stuff is. Health experts warn that unless humans stop overusing antibiotics, we are headed toward an existence in which antibiotics no longer work. It would be like slipping back into a distant past when a simple infection could be a death sentence.
So good for the U.N. for making this a high-level international priority. And good for the Los Angeles County officials who announced plans last week to require hospitals to report when patients are infected with carbapenem-resistant enterobacteriaceae, or CRE. Carbapenem is one of the antibiotics of last resort prescribed by doctors when the usual treatments fail.
And good for Sen. Jerry Hill (D-San Mateo) for reviving his effort to get hospitals to report drug-resistant microbes. He said Monday he plans to introduce legislation when the new session opens in December that would require hospitals to report CRE and other deadly superbugs that public health officials determine are active in the state.
Lest anyone think that the senator is merely headline chasing, Hill joined the drug-resistant infection fight long before it became such a global concern. In 2015, he authored Senate Bill 27, the nation’s toughest law to curb antibiotic use in agriculture. More than 70% of the antibiotics designed for human care are used in agriculture, where they historically have been used prophylactically for growth promotion and disease prevention. When the law goes into effect in 2018, it will allow antibiotic use on livestock only to control and treat infections.
In 2014 a Hill proposal to require hospitals to have an antibiotic stewardship policy originally included a provision to track superbugs, but it was taken out before the bill was passed due to concerns about cost. That’s too bad; if the Legislature had adopted the tracking provision, the state might have been years ahead on reporting superbugs.
The county's policy change and Hill’s announcement came just days after the Los Angeles Times reported that the incidence of CRE was going underrerported in California. The state does not require hospitals to disclose when this particularly lethal antibiotic-resistant microbe infects patients. Nor does it track when patients with superbug infections die. Determining the cause of death is left to physicians, and they don’t always report when an antibiotic-resistant infection acquired in the hospital contributed to a patient’s demise.
The state does require the reporting of antibiotic resistance in some cases, including hospital-wide infections due to C.difficile, which causes severe intestinal illness, and MRSA, the dreaded but rare methicillin-resistant staph infection. But that’s a small part of the picture, and health officials need all of it to develop an effective superbug-fighting strategy.
The U.S. Centers for Disease Control and Prevention estimates that in the United States, superbugs sicken 2 million people and kill about 23,000 a year. Many of those antibiotic-resistant infections are contracted in hospitals. The number is not reliable; it could be, and probably is, higher. It would help if physicians and hospitals were required to report when a patient dies after contracting an antibiotic-resistant microbe. But the CDC can only recommend reporting standards, it can’t mandate them. That’s up to the states.
California lawmakers should act swiftly on Hill’s bill to improve the reporting of antibiotic-resistant microbes. In a very real sense, what we don’t know about superbugs can kill us.