Antibiotic-resistant infections have become significant threats to citizens of NEW JERSEY:
Drug-resistant Staphylococcus aureus:
- Although primarily affecting ill people in hospitals,
Methicillin-resistant Staphylococcus aureus (MRSA), a drug-resistant
bacteria, are infecting a growing number of people in the community and
outside hospitals, including healthy athletes and children. A recent
study in the Journal of the American Medical Association
demonstrates that MRSA alone infects more than 94,000 people and kills
nearly 19,000 annually in the United States – more deaths than those
caused by emphysema, HIV/AIDS, Parkinson’s disease, and homicide.2
- Hospitalizations for or complicated by MRSA infectioncs cost nearly
double that for non-MRSA stays – 14,000 for MRSA stays compared with
$7,600 for non-MRSA stays. The average length of stay in the hospital
for a patient with MRSA infection was more than double that for non-MRSA
stays – 10.0 days versus 4.6 days.3
- Methicillin-resistant Staphylococcus aureus (MRSA)
continues to be identified as a problem in healthcare settings,
correctional facilities, and the community at-large in New Jersey.4
- The New Jersey Legislature passed a bill in August 2007 which calls
for hospitals to perform MRSA screening in intensive care units or other
“high-risk” areas in an effort to reduce acquisition of MRSA in
hospital settings, but no state appropriations were attached.
Drug-resistant “gram negative” bacterial infections:
- Serious and life-threatening infections due to antibiotic resistant
“gram negative” bacteria are on the rise across the United States. Gram
negative bacteria primarily are differentiated from gram positive
bacteria, like MRSA, by a cell wall that is particularly adept at
preventing antibiotics from entering the bacteria. These infections,
primarily acquired in hospitals and long term care settings, are
extremely difficult to treat and cause significant numbers of illnesses
and deaths. Bacteria in this group include: Escherichia coli (E.
coli), Klebsiella pneumonia, Pseudomonas aeruginosa, and Acinetobacter.
- In March 2009, CDC published guidelines for detection and control of
E. coli and Klebsiella species with increasing resistance to a subclass
of antibacterial drugs known as carbapenems. Carbapenems are among the
most potent antibiotics currently available and are often considered
the “last line of defense” in the treatment of antibiotic resistant
bacteria. Studies have shown that the mortality rate from infections
caused by carbapenem resistant Klebsiella species is roughly 40%. CDC
described this problem as “another in a series of worrisome public
health developments regarding antimicrobial resistance among
gram-negative bacteria [that] underscores the immediate need for
aggressive detection and control strategies.”5
- Noteworthy, these organisms are difficult to detect with the
automated testing systems currently used in most hospital laboratories.6
- Of critical importance, there are few to no approved antibacterial
drugs currently available to treat many gram negative bacterial
infections and few to no new drugs in the pipeline; drug discovery in
this area is extremely difficult due to challenges in overcoming the
gram negative bacteria’s cell wall.
Other antimicrobial resistance issues:
- Multidrug-resistant gram-negative bacteria (esp., ESBL-producers)
are increasingly being reported as causes of nosocomial outbreaks
occurring in New Jersey hospitals and other healthcare settings outside
the state.7
- Clostridium difficile (C. diff) is spawning
infections in hospitals in the U.S. and abroad that can lead to severe
diarrhea, ruptured colons, perforated bowels, kidney failure, blood
poisoning and even death. CDC estimates there are 500,000 cases of C. diff
infection annually in the U.S., contributing to between 15,000 and
30,000 deaths. The disease is very difficult to treat and recurs in at
least 20% of cases, even when treated appropriately. A new more virulent
strain of this organism is spreading throughout the United States.
- Deaths from C. diff in New Jersey have increased steadily
over the past few years. There were 64 in 2000, 81 in 2001, 133 in
2002, 154 in 2003, 195 in 2004, and 314 in 2005.8
- There were 12,089 hospital discharges in 2006 in New Jersey that included C. diff as a diagnosis, according to the Agency for Healthcare Research and Quality (AHRQ). The cost per C. diff patient in a hospital is estimated by CDC to be at least $3,500, making the annual healthcare cost for C. diff in New Jersey more than $42.3 million.9
Public health laboratory capacity:
Public health laboratory capacity is a key factor in New Jersey’s
ability to detect, monitor and control antimicrobial resistance. Across
the nation, increasing cases of antimicrobial resistance are currently
swamping the ability of each state's public health laboratory to keep
pace. There has been limited funding in the past for antibiotic
resistance education programs and surveillance, and even this limited
funding is on the decrease. Approximately only half of state public
health labs can provide some basic resistance testing. Like many
states, New Jersey lacks the targeted technical ability to promptly
detect and characterize emerging resistance patterns in a range of
pathogens. Therefore, such resistant organisms continue to spread
unrecognized and unimpeded throughout the state.
1 Dr. Fred Tenover, quoted in “The Bacteria Fight Back” Science, July 18, 2008.
2 R. Monina Klevens et al. “Invasive Methicillin-resistant Staphylococcus aureus Infections in the United States,” JAMA, October 17, 2007: 1763-1771.
3 Elixhauser, A. and Steiner, C. Infections with Methicillin-Resistant Staphylococcus Aureus (MRSA) in U.S. Hospitals, 1993–2005. HCUP Statistical Brief #35. July 2007. Agency for Healthcare Research and Quality.
4 NJ Department of Health and Senior Services, e-mail of Sept. 19, 2007
5 CDC MMWR “Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities” March 20, 2009 / Vol. 58 / No. 10
6 K. F. Anderson, et al.; Evaluation of Methods To Identify the Klebsiella pneumoniae Carbapenemase in Enterobacteriaceae; Journal of Clinical Microbiology, August 2007, p. 2723-2725, Vol. 45, No. 8
7 NJ Department of Health and Senior Services, email of Sept. 19, 2007
8 CDC Wonder Death Certificate Data, cited in a July 28, 2008 communication to Senator Sherrod Brow
9 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), Agency for Healthcare Research and Quality, www.hcupnet.ahrq.gov/, cited in a July 28, 2008 communication from CDC to Senator Sherrod Brown