Escalation Of Antibiotic-Resistant Infections Is A 'Train Wreck'
The increase in antibiotic-resistant infections is an escalating medical problem. The misuse of antibiotics has enabled some bacteria to adapt, rendering some drugs ineffective.
According to the Centers for Disease Control and Prevention, at least 2 million people in the United States become infected with bacteria that are resistant to antibiotic each year. And more than 20 thousand die annually as a result.
To learn more about this public health threat, Reno Public Radio’s Anh Gray sits down with Dr. James Wilson, who heads the Nevada Center for Infectious Disease Forecasting at the University of Nevada, Reno.
Q: As a pediatrician and a disease forecaster, how concerned are you about the increase in antibiotic-resistant infections?
A: There’s a bit of context from my perspective. I’ve been involved with providing warning and assessments for every possible infectious disease crisis you can think over the last 25 years. I was involved with SARS, MERS, Ebola, Zika, laboratory accidents, bio-terrorism, bio-weapon deployments. This is actually the most concerning issue I’ve ever seen in my career.
Q: How did antibiotic-resistant infections get so out of hand?
A: There’s a lot of complexity here. We have a lot of bacteria that we have to treat in medicine, we have a lot of drugs available at our disposal—antibiotics. But this country over the last century has evolved from a society of want versus a society of need. What we’re really seeing is the effect of what happens when you give the patient what they want to an extreme. We have a very high public demand for antibiotics and access to antibiotics. Really, we’re facing a time when we can’t use any of these antibiotics for the most basic infections. We’re going to see a dramatic increase in health care expense, increase in morbidity, increase in mortality, at a time when we really don’t need any more stress placed on our already fragile health care infrastructure.
Q: How serious is this problem in Nevada? What are the types of infections that should be effectively treated by antibiotics but are starting to become less effective?
A: One of our focus is on the elderly population. So we have a very substantial population of elderly citizens who have come to this state to retire, or have already been here. And with the advancing baby boomer generation that is set to retire soon, the biggest health care sector in the nation is the elderly. And that’s the population where the most antibiotics are used for things like urinary tract infections. Urinary tract infections are another focus for us because it’s one of the most common reasons to give antibiotics. They are often given inappropriately, the patient does not typically have an actual infection involving the urinary tract.
Q: How does this then affect the cost of health care?
A: The cost of care is estimated to triple if the urinary tract infection proceeds to sepsis. This is an infection where in a small number of patients, they have transference of the bacteria into their blood and that precipitates a condition known as sepsis, and that puts them into the intensive care unit. And you literally move from a 10X to 100X increase in health care expense when that happens. It’s also very difficult for the families to afford. So it looks like a train wreck; you see the wall coming and yet the train runs into it anyways. When you analyze the data, you see that we’re not using antibiotics appropriately; we’re using too many antibiotics. And we’re literally driving patients with what would have otherwise normally been an easily treatable condition, now cannot be treated. This is the disaster that we’re looking at.
Q: So what can be done to stem that disaster, to prevent it entirely or at least to slow down that train wreck that you’re referring to?
A: Well, there have been some studies showing very clearly that if you’re paying attention to proper infection control measures and proper cleaning of the patients’s rooms—you can reign it in—you can actually flat line the progression of resistance, and the progression of disease. If you’re able to properly manage how you use your antibiotics, and the seriousness of which you’re using those antibiotics, and being very judicious about the use of the antibiotics that you can actually slow down resistance trends. You can actually in many cases, bring back the use of drugs that were once rendered totally resistant—if you manage your antibiotics appropriately. But right now, I have yet to really see a concerted effort in this state to appropriately manage our antibiotics. It just hasn’t happened yet.