Hospitals keep quiet as 'superbug' epidemic spreads*

'Superbug' spreading, but statistics about it aren't

Texas hospitals don't have to make cases of deadly infection public

By ALEXIS GRANT
Houston Chronicle

DEADLIER THAN AIDS

The "superbug" called MRSA now kills more people than AIDS.

• Infection: Pronounced MUR-suh, methicillin-resistant Staphylococcus
aureus can be deadly.

• How it's spread: By personal contact or use of infected personal items
such as towels or razors.

• Treatment: Skin infections should be drained by a doctor, but more
serious infections, such as those that enter the bloodstream, require
intravenous antibiotics. Since it's resistant to common antibiotics,
only some drugs are effective.

• Symptoms: Mild infections on the skin can look like pimples, boils or
spider bites, while surgical-wound and bloodstream infections can cause
fever, fatigue or rash.

Source: Centers for Disease Control and Prevention

The antibiotic-resistant bacterium called MRSA is infecting more victims
across the country, but most states, including Texas, are not tracking it.

The so-called "superbug" kills more people than AIDS, according to a
recent report by the Centers for Disease Control and Prevention, which
estimates that 18,700 people nationwide died of invasive MRSA in 2005.
AIDS claimed about 17,000 lives in this country that year, the CDC reports.

The report resulted from the first federal study to track
methicillin-resistant Staphylococcus aureus, a form of staph that has
haunted health professionals for the past few years but grabbed the
public's attention only recently after several students in different
parts of the United States died from a strain they caught in the community.

The infection traditionally has spread only in health care settings, and
85 percent of the more serious cases still originate there, according to
the CDC. But now that it has made its way into the community, MRSA
(pronounced MUR-suh) is becoming a household word.

Most hospitals track infections transmitted within their own grounds; a
spokeswoman at one Houston hospital said it would be negligent not to
keep that data. But few hospitals are willing to make the information
public, either through the media or to their patients.

And they don't have to.

Unlike a long list of illnesses, including chicken pox, syphilis and
Lyme disease, MRSA isn't a required reportable condition in Texas. So
while hospitals may know their infection rates, the public often can't
get that information.

"There's just a concern about public reporting and whether it would be
interpreted correctly," said Dr. Rajiv Jain, director of the Veterans
Affairs national MRSA initiative, which involves testing every admitted
patient for the infection. Jain believes more in-depth tracking is needed.

Hospital administrators are reluctant to release infection-rate data,
partly because they're worried that the public will use it to compare
them with other hospitals that track the infection differently or that
serve patients with different risk factors.

But without data, some patient advocates say, it's difficult to hold
hospitals accountable.

New law, but no funding

The Texas Legislature this year approved a law that requires reporting
of health care-associated infections, although it doesn't specifically
target MRSA. Like most laws adopted in about 20 other states in recent
years, the new rules focus on the nature of an infection, not the type
of bacteria that caused it. So while some infections caused by MRSA
would be counted, they wouldn't be recorded as MRSA.

The law requires that three types of hospital-acquired infections be
reported: surgical-site infections, respiratory syncytial virus — which
causes pneumonia — and certain bloodstream infections. But since the law
doesn't include funding for the project, state health officials are
struggling to figure out how to pay for it.

"It's still not clear what funding is going to be available and if it's
going to be sufficient to make things work," said Dr. Tom Betz, manager
of infectious disease surveillance and epidemiology for the Texas
Department of State Health Services. "If we can't do this right, we
probably shouldn't do it at all."

While some health professionals, including Jain, say states should track
MRSA specifically, others say that wouldn't do much good, partly because
the staph infection can manifest in so many forms. Infections on the
skin, which can look like pimples or boils, can be treated fairly easily
and become potentially fatal only if the infection spreads to the
bloodstream or infects a surgical wound.

Origin hard to determine

Then there's the difficulty of determining the mode of transmission:
Hospitals can't always differentiate between infections that originate
in their facility or in the community.

"To track just MRSA by itself, that doesn't make a lot of sense," said
Dr. Sheldon Kaplan, chief of infectious disease services at Texas
Children's Hospital and professor of pediatrics at Baylor College of
Medicine. "There are lots of (other) hospital-acquired types of
infections that are just as serious."

That's no consolation for Cary Yates, a Missouri City man whose
29-year-old son Shawn died in March from community-acquired MRSA. It
took doctors several days to properly diagnose Shawn Yates, a father of
two, and then it was too late, his father said.

"The medical community must take this seriously," said Yates, a banker.
"They must hold themselves accountable and responsible and report these
numbers so we can have an open dialogue to try and cure this disease or
at least recognize it."

Bexar County to be first

Bexar County, which includes San Antonio, soon will become the first in
the state to track the infection. Under a state law approved in June,
all clinical labs in the county will be required to report MRSA
infections as soon as January. Lawmakers say the tracking system may
later be expanded to the rest of the state if it's successful.

"The whole goal of getting the data is to get a baseline, so you can
identify risk factors and then recommend measures to reduce those
rates," said Dr. Bryan Alsip, assistant director of clinical and
population-based services for the San Antonio Metropolitan Health District.

Bexar County has agreed to fund the pilot program. But for hospitals
strapped for money and staff, tracking yet another condition could pull
resources away from patient care, said Dr. Ed Septimus, medical director
of clinical integration for The Methodist Hospital System in Houston.