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Topic: Infection Killed Almost 19,000 in 2005, Study Says (Read 778 times) |
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Walter Watts
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Just when I thought I was out-they pull me back in
  
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Infection Killed Almost 19,000 in 2005, Study Says
« on: 2007-10-16 18:52:42 » |
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Make no mistake about. The epidemic outlined below is a DIRECT result of ignorance in the physician-patient relationship.
The responsibility for this continued ignorance is shared equally between the doctors and the patients and is two-part.
Co-ignorant and co-responsible Part One:
Patients, especially parents-as-healthcare-proxies-for-their-children, demand a prescription for an antibiotic every time they, or their children, cough or sneeze.
Co-ignorant and co-responsible Part Two:
Physicians provide said prescription with no second thought about the inevitable development of antibiotic resistant strains of ordinarily benign organisms.
Solution:
The latter co-ignorant group need to develop strict, rationally conceived protocols for the use of antibiotics in every suspected case of infection, no matter how mundane! 90% of the time, this will simply mean NO PRESCRIPTION NEED BE WRITTEN AT ALL.
--Walter
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The New York Times
October 16, 2007
Infection Killed Almost 19,000 in 2005, Study Says
By KEVIN SACK
ATLANTA, Oct. 16 — Nearly 19,000 people died in the United States in 2005 after being infected with a virulent drug-resistant bacterium that has spread rampantly through hospitals and nursing homes, according to the most thorough study to be conducted of the disease’s prevalence.
The study, which was published today in The Journal of the American Medical Association, suggests that invasive infections with methicillin-resistant Staphylococcus aureus, or M.R.S.A., may be twice as common as previously thought, according to its lead author, Dr. R. Monina Klevens. If the mortality estimates are correct, the number of deaths associated with M.R.S.A. each year would exceed those attributed to HIV/AIDS, Parkinson’s disease, emphysema or homicide.
By extrapolating data collected in nine locations, the researchers established the first true baseline for M.R.S.A. in the United States, projecting that 94,360 patients developed an invasive infection from the pathogen in 2005 and that nearly one of every five, or 18,650 of them, died.
The authors, who work for the Centers for Disease Control and Prevention, cautioned that their methodology differed significantly from previous studies and that direct comparisons were therefore risky. But they said they were surprised by the prevalence of the serious infections they found, which they calculated as 32 cases per 100,000 people.
In an accompanying editorial in the medical journal, Dr. Elizabeth A. Bancroft, an epidemiologist with the Los Angeles County Department of Public Health, characterized that finding as “astounding.” She wrote that the prevalence of invasive M.R.S.A. — when the bacteria has not merely colonized on the skin, but has attacked a normally sterile part of the body, like the organs or bloodstream — is greater than the combined rates for other conditions caused by invasive bacteria, including bloodstream infections, meningitis and flesh-eating disease.
The study also concluded that 85 percent of invasive M.R.S.A. infections are associated with health-care treatment. Previous research had indicated that many hospitals and long-term care centers have become breeding grounds for M.R.S.A. because bacteria may be transported from patient to patient by doctors, nurses and unsterile equipment.
“This confirms in a very rigorous way that this is a huge health problem,” said Dr. John A. Jernigan, the deputy chief of prevention and response in the C.D.C.’s Division of Healthcare Quality Promotion. “And it drives home that what we do in health care will have a lot to do with how we control it.”
The findings are likely to further stimulate an already active debate about whether hospitals and other medical centers should test all patients for M.R.S.A. upon admission. Some hospitals have had notable success in reducing their infection rates by isolating infected patients and then taking extra precautions, like requiring workers to wear gloves and gowns.
But other research has suggested that such techniques may be excessive, and may have the unintended consequence of diminishing medical care for sequestered patients. The C.D.C., in guidelines released last year, recommended that hospitals attempt to reduce their infection rates by first improving hygiene procedures and that they resort to screening high-risk patients only if other methods fail.
Dr. Lance R. Peterson, an epidemiologist with Evanston Northwestern Healthcare, said the Chicago-area hospital system reduced its rate of invasive M.R.S.A. infections by 60 percent after it began screening all patients in 2005.
“This study puts more onus on organizations that don’t do active surveillance to demonstrate that they’re reducing their M.R.S.A. infections,” he said. “Other things can work, but nothing else has been demonstrated to have this kind of impact. M.R.S.A. is theoretically a totally preventable disease.”
Numerous studies have shown that busy hospital workers disregard basic standards of hand-washing more than half the time. This week, Consumers Union, the nonprofit publisher of Consumer Reports, called for hospitals to begin publishing their hand-washing compliance rates.
“This study just accentuates that the hospital is ground zero, that this is where dangerous infections are occurring that are killing people every day,” said Lisa A. McGiffert, manager of the group’s “Stop Hospital Infections” campaign.
Though the C.D.C. estimates that M.R.S.A. represents only 10 percent to 20 percent of all infections acquired in health-care settings, the bacterium is feared for its opportunism and deadliness.
First isolated in the United States in 1968, it is resistant to a number of antibiotics and can cause infections of surgical sites, the urinary tract, the bloodstream and the lungs, leading to extensive and expensive hospital stays. The bacteria can be brought unknowingly into hospitals and nursing homes by patients who show no symptoms, and then takes advantage of weakened immune systems, incisions and wounds.
Of the infections studied by Dr. Klevens and her colleagues, 27 percent were considered to have originated during a patient’s current hospital stay. Another 58 percent were deemed to be associated with a previous hospitalization, nursing home stay, surgery or dialysis. Only 14 percent were cases without a defined health care risk factor, meaning the infection likely originated in the community.
A major difference with previous analyses is that the new study compiled actual confirmed cases of M.R.S.A. infection, rather than relying on coded patient records that sometimes lack precision. In the new study, higher prevalence rates and death rates were found for the elderly, blacks and men. The figures also varied greatly by geography, with Baltimore’s incidence rates far exceeding those of the eight other locations studied.
Dr. Klevens said further research would be needed to understand the racial and geographic disparities.
The C.D.C.’s latest estimate of all infections associated with health care, also taken from a study by Dr. Klevens, was 1.7 million cases and 99,000 associated deaths in 2002.
Copyright 2007 The New York Times Company
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Walter Watts
Tulsa Network Solutions, Inc.
No one gets to see the Wizard! Not nobody! Not no how!
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Hermit
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Prime example of a practically perfect person
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Re:Infection Killed Almost 19,000 in 2005, Study Says
« Reply #1 on: 2007-10-17 08:20:45 » |
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Three more factors are involved IMO, two big self inflicted ones, and another strictly self-inflicted nastiness of unknown but potentially terrifying severity. In order:
The routine use of potent antimicrobials to establish aseptic conditions where they are not strictly required. This is a consequence of the combination of ignorance on the part of the users, marketing on the part of the cleaning companies, and advertising standards which demand that claims made are supportable.
The routine use of our best antibiotics as a prophylactic measure for high density farming, delivered in animal feed even before they are approved for human use. This is primarily a deliberate profit-driven decision made by our "wonderful", "ethical", "responsible" drug companies, as farmers don't really have a choice in this, they use whatever their mills supply, and the mills use whatever their representatives advocate and supply - and the reps work for the drug distributors. I say primarily as there is some reasonable justification for continuously using new broad spectrum antibiotics at prophylactic levels , and that is that the blood levels are just high enough to control infection - which is also low enough to promote the development of multispectral resistance, so this practice means that new antibiotics are continuously required.
Fighting wars in environments where wounds contaminated with nasty foreign organisms are unavoidable - and where carriers are then repatriated directly into non-isolated critical hospital facilities where overworked staff are likely to act as vectors to cross-transmit infections into the general population particularly via the families of service members. In addition, due to litigation and morale issues, this danger is downplayed so that those who have been in these environments are neither tested for, nor warned against transmitting alien phages into their family environments on their return. This is a very real threat and I anticipate seeing the identification of new multispectrum resistant bacteria in addition to Staphylococcus Aureus and Clostridium difficile in both the military nosocomial environment and in the general population.
Refer also [ Church of Virus BBS, Mailing List, Virus 2006, Nosocomial Infections : A Really Important Warning, Hermit, 2006-11-20 ] and [ Church of Virus BBS, General, Science & Technology, What you need to know about "superbugs", Hermit, 2006-08-17 ] and following pages including introductory material posted by Blunderov.
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With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
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Blunderov
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"We think in generalities, we live in details"
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Re:Infection Killed Almost 19,000 in 2005, Study Says
« Reply #2 on: 2007-10-17 17:46:26 » |
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[Blunderov] Perhaps, if our species survives, the present time will come to be known as the "Age of the Antibiotic Moment". We have latterly enjoyed a small time of precedence over the microbe in complete defiance of the usual rules of the evolutionary house which define two possible states of existence : the quick and the dead.
Suffice it to say that humanity has not so far given too many indications of being especially"quick".
Ian Flemings's discovery fifty or so short years ago looks to be no more than a tiny window of respite from the fourth horseman. Disturbingly, the Catholic doctrine of preserving any and all life at whatever cost is not without rational basis. We have come to take a lot for granted. As the Hermit has intimated, pestilence is a frequent, even inevitable, companion of war and it does not look as if there is going to be any less of that in the near to medium future. Sobering also is the realisation that Penicillin was invented more as a means of waging war than anything else.
The microbes* will inherit the earth.
*I'm offering the microbes at evens. "The meek" you can have at 10 to 1 and welcome. It's your money.
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