Healthcare Is Not the Same As Healthcare Budgeting: The CREs Are Going to Kill Us All Edition

Every so often, I blog about CRE, which is short for carbapenem-resistant enterobacteriaceae (E. coli and relatives). CREs are resistant to just about every antibiotic (the two drugs commonly used, colistin and tigecycline, cause renal failure or are used off-label respectively; now, we’re seeing strains resistant to those drugs). CRE are the scary superbugs, not vancomycin-resistant MRSA (sorry, Scary Disease Woman). Unlike VMRSA, which evolves in sick patients in hospitals* and is unfit in the absence of antibiotics, thus making spread difficult, CREs seem to be relatively fit in the absence of antibiotics. In addition, the resistance plasmid, a mini-chromosome that carries the resistance genes and can jump from bacterium to bacterium, transfers at a very high rate. And there are recent reports from Southeast Asia of finding CREs in water samples–that is, outside of healthcare institutions.

The rise of CREs is the Big One. Which brings us to an excellent USA Today story about CREs. In it, Peter Eisler writes (boldface mine):

The superbug that hit UVA four years ago — and remains a threat — belongs to a once-obscure family of drug-resistant bacteria that has stalked U.S. hospitals and nursing homes for over a decade. Now, it’s attacking in hundreds of those institutions, a USA TODAY examination shows, and it’s a fight the medical community is not well positioned to win.

This is not a problem for the medical community. This is a systemic failure of our healthcare system. Infecting patients with difficult-to-impossible to treat bacteria is not good healthcare. Not only will CREs increase mortality rates, but if carbapenem-resistance establishes itself in the larger E. coli population, a significant fraction of commonplace urinary tract infections will become untreatable. The amount of misery this would cause would be significant–UTIs would be the new STD. And keep in mind, that there are already roughly 36,000 E. coli associated deaths per year in the U.S., which blows U.S. HIV/AIDS deaths out of the water.

At best, I figure we probably have five years, give or take, to get this under control before it spirals out of control (and in the past, I’ve been uncharacteristically optimistic about CREs). Thanks to our political system, which has been utterly warped by deficit reduction hysteria, are we worried about this or any other number of emerging problems (e.g., drug-resistant gonorrhea)?

Of course not. Don’t be silly. Instead, we’re worried about bending thirty-year budget curves like Beckham (as the kids used to say). Rather than worrying about real healthcare problems–that is, improving health and preventing disease–it would appear that the pressing healthcare issue of our age is budgetary. This might sound familiar (got Low Unemployment?), and brings to mind something Dan Kervick wrote:

When our children and grandchildren look back to assess our performance during this era, they will bitterly note that during a time when we should have been aggressively expanding public investment to employ all of our many unemployed people, launch bold projects for national renewal and progressive development, save our planet and light a rocket under our massively underutilized productive capacity to build a prosperous future for our progeny, we instead chose to get bogged down in ridiculous and priggish bean-counting and budgetary hand-wringing. Right now, it looks like we will be known as the generation that chose stagnation, blinkered bookkeeping and fiscal tunnel vision over dynamic national progress – a weak, cowardly and unimaginative people – the Lamest Generation.

I would simply add that we are choosing blinkered bookkeeping over basic health too.

*There are eleven known cases in the U.S. All of them arose in sick patients who were already under contact precautions.

This entry was posted in Antibiotics, E. coli, Fucking Morons, Healthcare, I For One Welcome Our Austerity Overlords, KPC, NDM-1. Bookmark the permalink.

4 Responses to Healthcare Is Not the Same As Healthcare Budgeting: The CREs Are Going to Kill Us All Edition

  1. Maryn says:

    Ha. No need for the apology; I don’t disagree, about CREs. In fact since Superbug the book came out, CREs are the resistance problem I have written about most, including a long piece in Scientific American about 18 months ago. (BTW, USAT’s story is good and detailed, but a number of excellent reporters have been covering this issue for several years now. There’s an inevitable marketing posturing around big packages like this — No One Else Has Written About This Evar! — that I really wish we could all skip, as it’s almost never accurate.)

  2. Zachary Smith says:

    I try to keep up with medical news, but this piece was the first one I’ve seen which managed to educate me about how there are different kinds of antibiotic resistance.

    From the Eisler link:

    *** • There is no reliable national data on the scope of the CRE problem. The CDC has urged states to track cases, but only a handful do so — and they’re just getting going. “We don’t have enough … data to tell what the trend looks like,” says Stephen Ostroff, director of epidemiology at the Pennsylvania Department of Health. “All we know is that it is here.” ***

    and

    *** There is no billing code for CRE infections under Medicare or Medicaid, the health care programs for the elderly, poor and disabled, and there’s no federal reporting requirement for the infections. So getting a reliable national picture of prevalence or where cases are concentrated is a challenge. ***

    So I’m compelled to agree “This is a systemic failure of our healthcare system.”

    The bean counters are winning in Washington, DC, for nothing is as important as more tax cuts for Rich People.

    Nothing.

  3. Pingback: Some Calmness Regarding Our ‘Looming’ Healthcare Crisis | Mike the Mad Biologist

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