Nearly 35,000 people in the United States are dying each year from drug-resistant infections, public health officials said on Wednesday, an alarming problem that New York state underscored by revealing that it had found one particularly new and virulent fungus in 64 hospitals and 103 nursing homes.
The numbers show just how widespread drug resistant infections have become, with the latest projection of deaths in America double previous estimates.
Where Candida Auris Patients Were Treated in New York State
New York health officials disclosed the names of the institutions with cases in the state because of how rapidly C. auris has spread.
“A lot of progress has been made but the bottom line is that antimicrobial resistance is worse than we previously thought,” said Michael Craig, the senior adviser on antibiotic resistance for the Centers for Disease Control and Prevention, which released the updated death toll on Wednesday. “Every 11 seconds someone in the United States gets a resistant infection and someone dies every 15 minutes.”
The C.D.C. report came on the same day that New York became the first state to release the names of the medical facilities that have treated patients with Candida auris, a fungus that is resistant to major medicines and has been spreading globally under a cloak of secrecy.
C. auris is one of the newer and more mysterious examples of such infections. The New York Times has spent the past year documenting its rise as multiple governments declined to identify or confirm the names of hospitals and nursing homes with the presence of C. auris. Some hospitals, including major academic institutions, declined to discuss cases even when family members or physicians confirmed them.
New York health officials said they decided to break with that practice and disclose the names of the institutions with cases in the state over the past three years because of how rapidly C. auris has spread. Their aim, they said, was to provide transparency to consumers and encourage hospitals and nursing homes to help stop its spread.
The state found that the heaviest concentration of C. auris patients was in Manhattan, Brooklyn and Queens. It did not say how many cases were at each institution and or identify patients.
The new C.D.C. report, a comprehensive look at the nation’s battle against antimicrobial resistance, said that 2.8 million people are sickened each year in the United States from pathogens that have learned to outsmart antimicrobial drugs, an increase of 800,000 per year since the previous report was issued in 2013. Officials said the updated figures reflected advances in data collection made possible by electronic medical records.
The findings were not entirely dire. The agency documented a 30 percent decline in deaths among patients who acquire drug-resistant infections in hospitals, a reduction it attributed to better hygiene among nurses and doctors who in recent years have been bombarded with messages about the importance of hand washing.
Among the greatest threats the report cites are a form of drug-resistant gonorrhea that has been spreading among young people and gay men, tough-to-treat urinary tract infections that strike otherwise healthy women, and Clostridioides difficile, or C. diff, a deadly bacterial infection that ravages the guts of hospitalized patients, sickening 224,000 and killing 12,800 each year.
On the flip side, the C.D.C. reported substantial declines in cases of MRSA, a bacterial infection sometimes referred to as a “superbug” and infections like Pseudomonas aeruginosa, an infection that often strikes nursing home residents on ventilators and patients recovering from surgery.
The C. auris cases identified in New York on Wednesday included patients who were infected and those who are “colonized,” which means they have it on their skin but are not showing symptoms. Some colonized patients eventually become ill and some do not, but all have the potential to spread the germ. The state also listed several cases of patients believed to be
possibly colonized.
The germ, which is typically resistant to one or more major antifungal medications, preys on people with compromised immune systems, and spreads with ease on equipment, clothing and skin.
About half of patients who contract C. auris die within 90 days, although the patients are typically infirm and so it is not clear whether they die from the fungus or it merely is among an ultimately lethal combination of poor health factors. There have been 806 confirmed cases of C. auris infection in the United States; 388 are in New York.
In releasing the hospital and nursing home data, New York State officials implored patients not to avoid going to medical facilities just because they have treated C. auris patients. In fact, the hospitals and nursing homes listed may well be doing a good job of containing the fungus, said Dr. Howard Zucker, the commissioner of the New York State Department of Health.
transcript
Revenge of the Bacteria: Why We’re Losing the War
Bacteria are rebelling. They’re turning the tide against antibiotics by outsmarting our wonder drugs. This video explores the surprising reasons.
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There once was a man named Albert Alexander. He was a policeman — “[American accent] Hey.” — in England. “[British accent] Hello.” One day on patrol, he cut his cheek — “Ouch!” — which led to a terrible infection. See, this was back in 1941, before patients had antibiotics. These were the days when a little scratch could kill you. “Or you got an ear infection and you died. A cat bite and you died. Or you stepped on a stick and you died. All of a sudden, antibiotics come along and bang.” The antibiotic era had begun. Soon a slow and painful death became a seven-day course of antibiotics and a $10 copay. And Albert? Albert was the first patient in the world to receive the antibiotic — penicillin. And it worked. “We just came up with a lifesaving, life-extending drug, one of the greatest developments in human history. Except not.” That’s Matt Richtel, a science reporter for The New York Times. For the past year, Matt’s been talking to health experts to find out if we are reaching the end of the antibiotic era. Modern medicine depends on the antibiotic. “And having used it so much, we’re now putting it at risk. Is our fate sealed?” “First off, I don’t think people respect bacteria enough.” This is Ellen Silbergeld, one of the leading scientists studying antibiotic resistance. “Bacteria rule the world. We are just a platform for bacteria. Within the human body, there are more bacterial cells than there are human cells. So we are, in fact, mostly bacteria.” “Alexander Fleming —” the man who discovered penicillin “— in his Nobel speech said, hang on, be aware. When you start killing this stuff off, it’s going to fight back.” “Did we pay any attention to that? No.” “The C.D.C. got our attention today with a warning about what it calls ‘nightmare bacteria.’” “These are bacteria that are resistant to most, if not all, antibiotics.” When we take antibiotics to kill infections, some bacteria survive. It used to be they’d replicate, and eventually resistance would grow. But now, they’re way more efficient and share drug-resistant genes among themselves. So every time we take an antibiotic, we risk creating stronger, more resistant bacteria. And stronger, more resistant bacteria means less and less effective antibiotics. And this is a problem because we take lots of antibiotics. “Money gets made over the sale of antibiotics.” Big money. Globally, the antibiotics market is valued at $40 billion. And in the U.S., the C.D.C. estimates that about 30 percent of all prescribed antibiotics are not needed at all. That’s 47 million excess prescriptions. And in many places outside of the U.S., you don’t even need a prescription. “You can walk into a pharmacy. A pharmacist will diagnose you and give you antibiotics. I tend to think of it as a story of Darwinian forces multiplied by the pace and scale of global capitalism. In an interconnected world — travel, import, export — we’re moving the bugs with us.” “I can go to a meeting in China or Vietnam or some place —” This is Lance Price, the director of the Antibiotic Resistance Action Center. “I can become colonized by untreatable E. coli. And I might not have any symptoms. But you can get colonized. And you can become this sort of long-term host.” So you could be healthy and still spreading bad bacteria without even knowing it. “Drug-resistant bacteria have never been able to travel the world as fast as they do today.” And that’s just part of the problem. “You should know that about 80 percent of antibiotic production in this country goes into agriculture.” “Why on earth did somebody think putting antibiotics in agriculture was a great idea?” “We’ve said, hey, look, cram these animals together. Don’t worry too much about hygiene or trying to keep them healthy. Just give them antibiotics. And then in a couple weeks, you’re going to have full-grown animals that you can chop up and eat. Right? And you can make money off of that.” “Nobody was making the connection between feeding animals antibiotics and the fact that the food would be carrying drug-resistant bacteria.” So Ellen did a study. She compared different kinds of store-bought chicken. And she found that poultry raised with antibiotics had nine times as much drug-resistant bacteria on it. “Now, let’s talk about the vegetarians. I just want you to understand, you’re not safe. You know all these outbreaks that take place among the lettuce and the things like that. Have you ever wondered how that happened? It’s because animal manure is used in raising crops. Organic agriculture lauds the use of animal manure.” “Unless you’re just a complete, ‘I’m a vegan, and I only hang out with vegans, and I eat sterilized vegetables,’ you know, it’s very likely that you’re picking up the same bacteria.” Resistant bacteria seep into the groundwater, fly off the back of livestock trucks and hitch a ride home on the hands of farm workers, all of which makes trying to pinpoint exactly where resistant bacteria is originating extremely difficult. And even when it seems like there is a clear source, things still aren’t so simple. “No one wants to be seen as a hub of an epidemic.” Say your grandmother makes you a rump roast. And then that rump roast makes you sick. Well, if you live in France, or Ireland, or pretty much anywhere in the E.U., packaged meat has a tracking label. You can figure out exactly what farm that meat came from. But in the U.S., not even the top public health officials can do that. “Most countries have animal ID laws. We don’t.” Pat Basu, former chief veterinarian for the U.S.D.A.’s Food Safety and Inspection Service, basically one of the top veterinarians in the country. “Let me start at the beginning. We got a case where we had resistant bacteria causing illness in people. There were sick people that C.D.C. identified.” “More than 50 people in eight counties have gotten an unusual strain of salmonella linked to pork.” “This is not your grandmother’s pathogen anymore. This is a new bug.” Health officials traced the outbreak back to the slaughterhouse and identified six potential farms where the outbreak could have come from. But then the investigation shut down. “The individual farmers have to agree voluntarily to share the data with these investigators who go out. We couldn’t go any further back. It was a dead end.” 192 people sick, 30 hospitalizations and zero access for health officials to investigate the farms. “The secrecy is maintained because there are big economic forces behind it. Farms are scared of losing their ability to get antibiotics. Hospitals are scared of driving away patients.” “Well, as a physician, I do get very upset. I get very upset, as a patient, that information is being withheld.” This is Kevin Kavanagh, a doctor and a consumer advocate for patients. “Drug-resistant bacteria is a huge problem. If it occurs at a restaurant, if it occurs in a cruise ship, you know about this immediately —” “A salmonella outbreak —” “within days or hours of an outbreak occurring.” “This morning, Chipotle is keeping dozens of its restaurants in the Pacific Northwest closed —” “But yet, in a hospital, it can take you months or even over a year until this data appears on a governmental website or reported by the C.D.C.” In the U.S., hospitals are under no obligation to inform the public when a bacterial outbreak occurs. “Defend and deny. They are very concerned about the short-term economic benefits, rather than looking at long-term problems.” “There’s always this response like, well, but there’s still a drug, right? Like, this isn’t the end.” Remember Albert Alexander? — “Hello. Ouch!” — the first patient to be given penicillin? Well, his story didn’t end there. Five days after he started recovering, the hospital ran out of the new drug, and Mr. Alexander died. Today, we don’t have to worry about antibiotics running out. We have to worry about using them so much that they stop working altogether. “— want to know why a metro health department didn’t shut down a restaurant —” “It’s a very resistant bacteria —” “We really need to change the way we use antibiotics. Because the way we use antibiotics is destroying them.” “It’s putting at risk the entire system of care that we depend on for lengthening our lives and improving the quality of our lives.” The British government commissioned a study which predicted a worst case scenario where more people will die by 2050 of these infections than will die of cancer. “That’s a generation from now.” “It takes 10 years to identify, develop, test and bring to market a new antibiotic. And it takes a billion dollars.” “This is a common issue for humanity.” “Very similar to global warming.” “You can’t control it as a single company. You can’t control this as a single government.” And because the bacteria are now working together so efficiently — “Unless the world acts consistently together, it doesn’t make a difference.”
At the same time, he said the germ has spread so quickly that hospitals and nursing homes need to acknowledge its presence and address it as they would other major drug-resistant infections tracked and made public by the state. Consumers, he argued, deserve to know “to help them make an educated decision for their life or someone dear to them.”
For hospitals and nursing homes, he said, there was a benefit, too. “If you can’t measure it, you can’t improve it,” he said.
New York is the first state to provide such data, said Michael Osterholm, the director for infectious disease research and policy at the University of Minnesota, where he runs a clearinghouse for information on drug-resistant infection.
“One of the challenges we’ve had is this climate of secrecy,” he said. “I applaud this,” he added. “It’s potentially a game changer because of the unique nature and consequences of dealing with this infection.”
The reports from the C.D.C. and New York, which also found improvements in hospital performance at the state level in dealing with drug-resistant infections, suggest that intensified scrutiny is making at least modest inroads into a worldwide challenge.
Drug resistance is a vexing, seemingly intractable problem owing to the powerful forces driving it: the biological reality that germs will develop defenses when threatened with extinction and modern medical, pharmaceutical and farming economies are built on the use of millions of tons of antibiotics and antifungal drugs.
Without change, the United Nations estimates that drug-resistant infections will kill 10 million people in the year 2050, more than the number projected to die that year from cancer.
C. auris has become an object lesson in many of the core policy debates and challenges, and that includes discussion about whether to disclose health care institutions that are battling the germ.
Loretta Willis, vice president for quality advocacy with the Healthcare Association of New York, which represents about 100 nursing homes in the state, said she worried New York’s disclosure could unnerve patients and their families. “Without a fuller understanding about what’s happening and what’s going on with these emerging infections, it may cause unnecessary panic,” she said.
“I’m worried it will be taken out of context,” said Ms. Willis, who is also a nurse, asserting that there are many germs these institutions deal with, that they are equipped to handle the situation and that it would be to the detriment of patients and their families to look at a list of facilities and say, “‘That’s horrible, I’ll never go there.’”
Brian Conway, a spokesman for the Greater New York Hospital Association, said, “While we have some reservations about hospitals being named, the hospital community is committed to doing everything we can to eliminate C. auris.”
He added that this week the group is releasing a five-minute training video for hospital and nursing cleaning crews about how to clean a room where a patient has tested positive for C auris. New York City, a major travel hub, can be among the first to face new germs and be forced to consider new policy positions.
But C. auris is growing elsewhere with institutions treating it still unknown.
California confirmed this week that the number of colonized patients has jumped in Southern California — from fewer than five this summer to 181. But California health officials declined to be interviewed by phone about the subject and responded in an email, “The California Department of Public Health (CDPH) is in the process of determining if facility names can be released.”
The state of Connecticut declined earlier this year to identify the hospital where one of the first C. auris patients was detected in the United States; a hospital in Chicago, Northwestern Memorial Hospital, also would not comment or provide any acknowledgment of the situation for an article that was published about a patient with C. auris who had died; doctors at several institutions around the world told The New York Times they could not speak about the patients they had seen or the spread of C. auris at hospitals where they worked, fearing reprisals from administration.
Dr. Zucker, the New York State health commissioner, said he hoped that other states would follow New York’s lead.
“We really live in an information-centric world and patients should have data,” he said.
