CDC Gives Congress an Offer it Cannot Refuse

August 18th, 2015

Perhaps the tone was set in the early days of the Ebola outbreak, when projected death tolls and disastrous outcomes were linked to urgent requests for money and resources.

Nevertheless, it is a bit shocking to see the Centers for Disease Control and Prevention – an agency that often plays a more patient political game of consensus building – send the realpolitik equivalent of a ransom note to Congress: “Give us the money or people are going to get hurt.”

Actually, an estimated 37,000 of them are going to die in the next five years of antibiotic resistant and Clostridium difficile infections (CDIs) unless Congress hands over $264 million dollars to the suddenly unsubtle CDC.

“If we just stay with business as usual, there will be hundreds of thousands of infections and tens of thousands of deaths that could be prevented,” Tom Frieden, MD, MPH, CDC director, said at a recent press conference. “We know what needs to be done and it's up to Congress to [provide] the resources needed to protect Americans.”

By all appearances, the CDC project is important enough to warrant that level of funding, as the agency is focusing on two of the most dangerous pathogens currently causing healthcare associated infections (HAIs): Clostridium difficile and Carbapenem-Resistant Enterobacteriaceae (CRE). C. diff causes close to half a million infections annually, with an estimated death toll of 15,000 patients. While this “deadly diarrhea,” as the CDC calls it, is currently causing misery and death far and wide, CRE is just beginning to establish itself in the healthcare continuum. Extremely drug resistant, if CRE gets established in the healthcare system we may start seeing infections that are difficult if not impossible to treat. CRE is leading the vanguard of antibiotic resistant bacteria, which have rendered useless whole shelves of that nation’s formulary and cause more than 2 million infections and some 23,00 patient deaths annually. The CDC is clearly concerned that CRE is going to continue to increase, raising the specter of a practically pan-resistant pathogen moving across the health care continuum to a variety of healthcare facilities that share patients but precious little information. The kicker – and perhaps the reason the CDC dubbed CRE the “nightmare” bacteria – is that CRE’s drug resistance mechanisms can genetically transfer in nature via plasmids to other types of bacteria, creating the possibility of more and different bugs for which few treatment options are available.

Given the full picture of what the agency is up against, it’s little wonder that the CDC raised the stakes by calling out Congress in public. The agency is requesting the money to set up “protection programs” in all 50 states and 10 large cities. The idea is to link healthcare facilities that see the same group of patients going in and out of their clinics, hospitals, long term care with health departments to share information on C. diff, CRE and other problem pathogens.

“These funds will also make it possible to [detect] outbreaks sooner, improve laboratory testing, and track antibiotic resistance much better than we can today,” Freiden said. “We really hope that when all is said and done, we can get the resources we need to help protect Americans so that people aren't unnecessarily at risk of getting serious and potentially fatal infections in healthcare facilities.”

For more on this important story see the September 2015 issue of Hospital Infection Control & Prevention.