Resistant Bacteria, Possibly Much Deadlier Than We Thought

Or as we often say around here, you have to understand the limitations of your data–in this case, hospital records (boldface mine):

Sharley McMullen of Manhattan Beach came down with a fever just hours after being wheeled out of a Torrance Memorial Medical Center operating room on May 4, 2014. A missionary’s daughter who worked as a secretary at Cape Canaveral, Fla., at the height of the space race, McMullen, 72, was there for treatment of a bleeding stomach ulcer. Soon, though, she was fighting for her life.

On her medical chart, a doctor scribbled “CRKP,” [carbapenem-resistant Klebsiella pneumoniae] an ominous abbreviation for one of the world’s most lethal superbugs, underlining it three times.

Doctors tried antibiotic after antibiotic. But after five weeks in the hospital, mostly in intensive care and on morphine because of the pain, McMullen died.

Her death certificate does not mention the hospital-acquired infection or CRKP, however. Instead, her doctor wrote that McMullen had died from respiratory failure and septic shock caused by her ulcer.

Dr. Yasmeen Shaw, who treated McMullen in the ICU and filled out the death certificate, said she was following directions from health officials by recording the underlying cause of death, which in her opinion was the perforated ulcer.

“Everything that happened to her health is a consequence of the initial condition she came in with,” Shaw said. “Had the patient not have had a perforated ulcer they wouldn’t have been in the hospital in the first place.”

This is not an isolated incident either:

University of Michigan researchers reported in a 2014 study that infections – both those acquired inside and outside hospitals – would replace heart disease and cancer as the leading causes of death in hospitals if the count was performed by looking at patients’ medical billing records, which show what they were being treated for, rather than death certificates

In March, the CDC estimated that the actual number of deaths from sepsis were as much as 140% higher than those recorded on death certificates, or as many as 381,000 deaths a year. According to another study, 37% of hospitalizations for sepsis were caused by infections caught in hospitals or other health facilities like nursing homes.

That suggests that as many as 140,000 Americans are dying each year from healthcare-acquired sepsis, just one subgroup of the infections….

One reason doctors are reluctant to report in public records that patients have died from hospital-acquired infections, experts say, is the possibility of malpractice lawsuits.

CDC officials warned in October that they had discovered that some hospitals had tried to stop their infection-control staff from reporting certain types of hospital-acquired infections to a national database as required.

In a 2010 survey published in a CDC medical journal, 49% of New York City medical residents said they had knowingly reported an inaccurate cause of death on a certificate.

To make things worse, only 24 states (which does not include California) require reporting of carbapenem-resistant infections (‘CRE’).

It’s also worth emphasizing the infectious disease burden, at least within hospitals, is probably higher than heart disease and cancer. Yet no one marches/walks/does the hokey pokey for a ‘cure.’ Just saying.

Before we consider massive electronic reporting systems (though they would help), we might want to make basic reporting of dangerous infections mandatory. And then add severe penalties to institutions that fail to report infections.

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