New numbers and the new normal: Progress against HAIs, but C. dif, CRE refuse to retreat

January 12th, 2015

On any given day in the U.S. one of every 25 hospitalized patients is infected by a pathogen acquired during hospital care. Every year 722,000 of these health care associated infections (HAIs) strike patients, with roughly 200 of them dying daily, according to the Centers for Disease Control and Prevention. As bad as that sounds, these recently released numbers are actually an improvement over the 1.7 million infections and 99,000 deaths annually that the CDC has reported for several years.

The needle is beginning to move, as MRSA infections that have plagued health care for decades are in retreat. However, pathogens like Clostridium difficile and multidrug resistant CRE “nightmare” bacteria are resisting reduction and even expanding in the face of these national efforts.

The CDC is warning with unusual candor that we are entering a post-antibiotic era where our miracle drugs have lost their efficacy due to chronic misuse and overuse. That leaves only antibiotics like colistin, which includes kidney failure among its possible side effects. The drug is so harmful to patients that clinicians have rarely used it over the years, ironically preserving its efficacy. Hard choices are being made. As previously reported in HIC, a man who fell off a roof and broke his leg developed an infection that was virtually untreatable. The patient was given the option of going on colistin and risking kidney failure or having his infected leg amputated below the knee. He chose amputation.

Though this sounds like something that would occur in a Civil War medical tent, it underscores why it is so important to for infection preventionists to prevent cross transmission of infections from patient to patient.