August 27, 2012

Multi-Drug Resistant Infections at the NIH Hospital—Is This the Future?

Tyler Smith

Tyler Smith

Program Officer, Food Production and Public Health

Johns Hopkins Center for a Livable Future

Courtesy CDC

Last Wednesday, The Washington Post reported on an outbreak of multi-drug resistant Klebsiella pneumoniae at the National Institutes of Health (NIH) Clinical Center in Bethesda.  (The Post was covering an interesting report by NIH investigators in Science Translational Medicine.)  Initially, the strain was resistant to all but three antibiotics.  It spread over several months, eventually colonizing 17 patients and killing six, and acquired resistance to these three drugs along the way.

The spooky headline in The Post—“‘Superbug’ stalked NIH hospital last year, killing six”—seemed to imply this was a freak occurrence.  It was not, unfortunately.  As antibiotic resistance has emerged as a full-blown public health crisis, this outbreak was just a sign of times…and of things to come.

The NIH did everything it could to control the outbreak: isolating colonized patients, requiring visitors to wear gloves and gowns, assigning staff and equipment to treat these patients exclusively, monitoring staff to ensure they were following correct procedures, and much more.  They even ripped out a kitchen sink when K. pneumoniae was discovered down its drain.  (Dr. Eli Perencevich, who blogs at the excellent Controversies in Hospital Infection Prevention, summed up these efforts nicely with a picture of a sink and this caption: “The kitchen sink: the problem and the current solution.”)

Dr. Perencevich argues that additional research on infection control is needed, so hospitals need not rely on (an ultimately inadequate) try-everything approach.  This makes sense.  Additionally, the fact that the K. pneumoniae was highly resistant to antibiotics is just one of many warning signs that we need to use our current antibiotics more responsibly—in hospitals and the community, and on farms—and invest in developing new treatment options, points that he and many others in medicine and public health (though not nearly enough) have made strenuously.

A policy priority for CLF is banning the use of antibiotics in food animal production for growth promotion and disease prevention.  These vital drugs are often continuously fed in small doses to livestock and poultry to make the animals grow faster and to reduce infections associated with the overcrowded and unsanitary conditions in which many food animals are raised.  As any infectious disease expert (not to mention many precocious high school biology students) can tell you, such practices are likely to select for antibiotic resistance.

The food animal industry has actively opposed efforts to reform its use of these drugs.  It must be compelled to do so by regulations.  The Food and Drug Administration has been derelict in its regulatory duties, however, asking drug companies to voluntarily withdraw approvals for antibiotic growth promoters but otherwise doing very little.  The agency has largely ignored misuse of these drugs for prophylaxis in food animals, and is on track to let drug companies sell more antibiotics for this purpose.

Perhaps it will take more stories like the one from the NIH Clinical Center to truly “get smart” about antibiotics.  Rep. Louise Slaughter, who has championed ending the misuse of antibiotics in food animal production, called the NIH outbreak “a canary in the coalmine.”  Hopefully we will learn from it.  If past is prologue, however, we may very well not.

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