The Spread of Superbugs

The U.S. Centers for Disease Control and Prevention has just published a first-of-its-kind assessment of the threat the country faces from antibiotic-resistant organisms.

And the news is not good.  In fact it’s downright scary. The agency’s overall conservative assessment of the problem includes frightening statistics such as:

• Each year, in the U.S., 2,049,442 illnesses caused by bacteria and fungi that are resistant to at least some classes of antibiotics
• Each year, out of those illnesses, there are 23,000 deaths
• Each year, those illnesses and deaths result in $20 billion of additional healthcare spending
• Each year, an additional $35 billion lost to society in foregone productivity.

The report marks the first time the agency has provided hard numbers for the incidence, deaths and cost of all the major resistant organisms. It also represents the first time the CDC has ranked resistant organisms by how much and how imminent a threat they pose, using seven criteria:

• health impact
• economic impact
• how common the infection is
• how easily it spreads
• how much further it might spread in the next 10 years
• whether there are antibiotics that still work against it
• whether things other than administering antibiotics can be done to curb its spread

Out of that matrix, their top three “urgent” threats they identified were:

• Carbapenem-resistant Enterobacteriaceae (CRE), a family of ICU germs that includes Klebsiella and  E. coli, that have become are resistant to almost all antibiotics, resulting in  9,000 infections per year and at least 600 deaths
• Antibiotic-resistant gonorrhea, which currently responds to only one drug: 246,000 infections per year
• Clostridium difficile,  which causes 250,000 illnesses, 14,000 deaths.

In addition, the CDC identified 12 resistant bacteria and fungal infections which the agency dubs “serious” i.e., requiring “prompt and sustained action.”  They include the hospital-acquired infections  Acinetobacter, Pseudomonas aeruginosa, and Vancomycin-Resistant Enterococcus (VRE) ; the foodborne organisms Campylobacter, Salmonella and Shigella; MRSA; Candida and TB.

The last category, “concerning” i.e., requiring “careful monitoring and prevention” includes rare but potent vancomycin-resistant staphylococcus aureus  (VRSA), as well as strains of streptococcus resistant to two different categories of drugs.

For each organism, the report explains why it is a public health threat, where the trends are headed, what actions the CDC is taking, and what it is important for health care institutions, patients and their families, and states and local authorities to do to help.

Commenting on the report, Ed Septimus MD, professor of internal medicine at Texas A&M Health Sciences Center in Houston says “It’s up to us to make the recommendations in this report happen. If we do nothing but say, ‘Here’s the problem,’ then the problem will continue to grow.”

Well said Doctor, well said.

Patients are from Mars, Physicians are from Venus!

Or so it would seem.  According to a study just published in the Annals of Internal Medicine there is a huge disparity between patients’ expectations of angioplasty versus those of their cardiologists.  While the majority of heart patients harbor the notion that angioplasty, a procedure performed to unblock clogged arteries, will cut their risk of heart attacks and death, cardiologists believe that its value is limited to reducing chest pain.

The research involved 27 cardiologists and 153 patients who consented to elective coronary catheterization and possible angioplasty, from Baystate Medical Center, Springfield, and Tufts University School of Medicine, Boston.

During angioplasty, a tube is inserted at the groin and snaked up to the affected artery, where a balloon opens the blockage. A stent is often left in place to help prop open the artery and maintain blood flow. Angioplasty involves some risk but the rate of death during the procedure is less than 1 percent, experts note.

Although 63% of cardiologists believed that the benefits of angioplasty were limited to angina symptom relief:

• 88% of patients believe that angioplasty would prevent heart attacks or fatal heart attacks

• 74% of patients thought that without the procedure  they would probably have a heart attack within 5 years

Furthermore, most patients stuck to their beliefs even after spending time with a cardiologist who explained the risks and benefits to them, and had them sign an informed consent form prior to the angioplasty.

The authors of the study noted that the benefits obtained by angioplasty can often be achieved with medication alone, and only patients who are actually having a heart attack or coronary event can expect a reduced risk of future heart attacks and death from angioplasty.

The number of angioplasties done for stable heart patients has decreased lately.  According to the American Heart Association, about 1.3 million such procedures are done in the United States each year.

Once again, this study highlights the “disconnect” between what doctors know and what patients understand. In order to have real informed consent, patients have to understand not just the risks, but also the benefits of whatever treatment is proposed.

One reason for patients’ misunderstanding is the common belief, that if a treatment is offered, it must have curative benefits.

However, the problem of patient understanding isn’t limited to angioplasty but is common in many areas of medicine. According to a previous study from the Mayo Clinic, doctors don’t always do a good job of knowledge transfer in a way that patients and family members can understand. Graphs and charts are not going to work for many patients.

SRxA and our team of problem based learning expert Advisors can help physicians, institutions and device manufacturers produce patient-centric materials to assist with informed consent. Contact us today to find out more.