Florida vs. the superbugs

April 13, 2009

This op-ed appeared April 6 in the St. Petersburg Times.

By: David Smith and Ramanan Laxminarayan

David Smith, Ph.D., is an associate director of disease ecology at the University of Florida’s Emerging Pathogens Institute in Gainesville. The Emerging Pathogens Institute brings together scientists to develop control and treatment strategies for pathogens like MRSA. Ramanan Laxminarayan, Ph.D., M.P.H., is a senior fellow at Resources for the Future, an independent and nonpartisan Washington think tank whose Extending the Cure initiative develops policy solutions to extend antibiotic effectiveness.

MRSA killed Alonzo Smith, an 18-year-old football player from Liberty High School in Kissimmee last September. Smith follows a long line of football players who have been sickened after infection with MRSA, a highly resistant superbug.

In fact, the National Football League was so concerned about the spread of MRSA in locker rooms that it sent a team of infectious disease experts to inspect seven NFL facilities. Last month, the NFL released a report showing that the teams, including the Miami Dolphins, were doing a better job of preventing the spread of MRSA.

That’s the good news.

Now for the bad: Every year, this resistant bacterium kills an estimated 19,000 people in the United States, including those who are apparently healthy. This “superbug” also causes serious problems in hospitals and other facilities where it can burrow into a wound or along a catheter — and trigger life-threatening infections. In fact, MRSA infections in hospitals have more than tripled since 2000, and doctors fear that the bug is evolving to resist even more antibiotics.

But MRSA is not the only superbug. Rates of resistance to a class of organisms called gram-negatives have skyrocketed recently. For one such organism called Acinetobacter, rates of resistance to carbapenems, considered last-resort antibiotics, have jumped from 9 percent in 1995 to 40 percent in 2004, meaning these infections are often completely untreatable — most often resulting in a death.

Florida has already taken one big step toward combating superbugs by requiring hospitals to report infections, like those caused by MRSA. But the state is in a unique position to do more than simply report such infections.

Florida gets 76 million visitors a year. Pathogens like MRSA and antibiotic-resistant gram-negative bacteria can live on the skin or in the nose, without causing harm. So, without knowing it, some tourists come to Florida with more than their luggage, and others leave with more than a tan. When tourists get sick in Florida, they connect Florida’s hospitals to the rest of the country.

If the state adopted a rigorous strategy of identifying and flagging patients with this bug it could take a lead in a national fight to stop the spread of these infections.

The economic stimulus recently signed by President Barack Obama includes $150 million to jump-start a national plan to contain health care-associated infections. But federal stimulus money should not be used to pay hospitals for infection-control measures that should already be a part of their daily routine, such as using sterile supplies and encouraging hand washing.

The problem is that hospitals have no incentive to put strategies in place that could curb the spread of infections from one facility to another. When tourists bring their antibiotic-resistant bugs into the state, Florida’s hospitals have to deal with the problem, and that costs money. Florida’s hospitals don’t get extra funds to cover the cost of setting up a surveillance system that includes alerting other facilities when a patient with MRSA is slated for transfer. So no one pays Florida, or anyone else, to do the simple things that stop the problem from being passed on.

So what can be done? We have to ensure that funds for infection control are spent on activities that encourage regional coordination of infection control rather than for activities that benefit the hospital alone. Centers for Medicare and Medicaid Services and the State Health Department should provide hospitals with tools and incentives to work together so that infections wouldn’t just be transferred from one place to the next.

The rising tide of infections in hospitals is only one part of the growing problem of antibiotic resistance. Superbugs like MRSA have emerged because of the overselling and overuse of antibiotics. Our national health leaders need to step out in front of this epidemic to implement a strategy that addresses all factors involved.

But Florida’s role in the fight against these superbugs is critical: If Florida reins in MRSA and other resistant infections, the impact would be felt far beyond the state line.