Wrong Directions: Pathogens are up, specialists are down

The hot paper we reported on yesterday said that you can reduce the 30-day mortality rate for hospitalized MRSA patients by more than half (from 23% to 10%) if you involve an infectious disease specialist in your care (along with your GP). According to the study’s lead author, having an ID consult is an absolute game changer: If there were a medicine that had such a dramatic effect, he said, “every patient would be on it.”

But there’s a problem – a lack of ID specialists. This has been reported on for several years now and various reasons are offered. Then just last week a report in Medscape addressed the issue again, identifying yet another reason for the shortage – a difficult diagnostic coding system used for tracking antibiotic-resistant infections is missing nearly 9 out of every 10 cases. And this has a domino effect: Grossly understating the problem of resistant infections means funding for research and treatment isn’t provided, which in turn “creates a strong disincentive for physicians to specialize in infectious diseases.”

So the researchers used a different method for identifying resistant infections – looking at evidence of treatment failure, defined as use of two or more therapeutic subclasses of prescription antibiotics to treat a bacterial infection – and found an 88% increase in the number of cases.

 

Rise in ABR infections

 

Looking at this new data over a 14-year period beginning in 2000, the authors conclude:

  • Rates of antibiotic-resistant infections have roughly doubled since 2002. “That while the overall number of [susceptible] bacterial infections remained relatively constant between 2002 and 2014, rising from 13.5 million to 14.3 million annually, the proportion that were antibiotic resistant rose dramatically, from 5.2% to 11.0%.”
  • The cost of care now tops $2 billion per year in the US. “Antibiotic resistance added $1,383 to the cost of treating a patient with a bacterial infection. Using an estimate of the number of such infections in 2014, this amounts to a national cost of $2.2 billion annually.”

They admit that even this is an undercount because they didn’t include data for institutionalized patients, such as those in nursing homes (a huge source of resistant infections), other long-term care facilities, prisons, and military or Veterans Affairs facilities, all of which typically have higher rates of antibiotic-resistant infections. Nor did the analysis include children, who, they say, “are the primary carriers of methicillin-resistant Staphylococcus aureus and pneumococcus in the community.”

In other words, resistant infections are on the rise, yet the very people who are able to cut by half the 30-day mortality rate in MRSA cases are on a relative decline, especially when you factor in one huge demographic: the aging thus increasingly vulnerable-to-disease baby boomer generation.

 

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