
‘Superbug’ scourge spreads as U.S. fails to track rising human toll - danso
http://www.reuters.com/investigates/special-report/usa-uncounted-surveillance/
======
daveloyall
Hello. I work for public health. My job is to support the computer systems
that allow epidemiologists to track 'superbugs' (and regular ones).

Deathcerts is an interesting dataset. It's not the only one.

Even if death-by-MSRA isn't tracked, I assure you that MSRA itself is tracked.

There's a specific class of lab test called "antibiotic susceptibilities". The
results report includes a bunch of numbers that represent just HOW resistant a
particular bug is to a standard battery of antibiotics, broken down per
antibiotic.

That data is transmitted from the labs that performed the test to the state
health department where it is analyzed.

Fascinating article, but there's NO WAY that Reuters had that much contact
with state public health folks without being aware that they track lab
results. Misleading!

Edit: elaborated about the susceptibilities results.

~~~
toss1
OK, so somebody's tracking it in secret, doing the 'antibiotic
susceptibilities' tests and logging the results, and the state health dept
receives the data, but the info is being kept from the patients' relatives and
from the public in general?

This creates two obvious results. 1) suppression of legitimate claims from
relatives, and 2) suppression of valid concern and pressure for govt action
such as increased research funding.

How is this good?

~~~
daveloyall
I'm not saying it is good. I'm just saying that there is more than one thing
going on here.

I don't think hospitals have any motivation to hide antibiotic-resistant
infections ("superbugs") specifically. HOWEVER, the motive to hide hospital-
acquired infections[0] is clear!

Here's some mud in the water: what's the difference between a HAI with some
bug that is easily killed by antibiotics vs. an antibiotic resistant bug?

As for "tracking it in secret", that's one way to put it, but it will cloud
your thinking. :) Your own medical records--specifically blood test lab
results--have your name, address, and phone number on them. Consider replacing
the word 'secret' with 'private' and re-working the whole thought.

0: [http://www.cdc.gov/hai/](http://www.cdc.gov/hai/)

~~~
InternetPerson
You start out by saying that the article is "misleading", and that MRSA is
tracked. The article is pretty convincing that it's not accurately reported.

Then you agree with the article that "the motive to hide hospital-acquired
infections is clear".

Uhh... That's kind of a huge problem.

~~~
daveloyall
Well yeah. But hey, I'm no journalist.

I stand by my assertion that nobody is trying to "hide" the "superbug"
problem.

The human tendency to not self-report failures is a thing. But it's not some
kind of biohazard conspiracy.

And one more thing about the death certificates...

    
    
        > In a statement emailed to Reuters, Frieden said: 
        > "While death certificates provide helpful 
        > information, the unfortunate reality is that they
        > don't provide in-depth clinical information."
    

I'm guessing that Frieden, the boss of the whole CDC, went on to say something
like: "But it makes sense, because death certificates are primarily legal
records. The clinical information lives in _medical_ records." OR, OR,
something more accurate. That's why he gets the big bucks. :)

~~~
InternetPerson
Well, you know more about this space than I do. So maybe it's not so bad...

But the article sure makes it sound like hospitals are hiding MRSA-related
deaths, since MRSA infections are often "hospital acquired". And we all agree
that hospitals would have an incentive to hide these numbers.

And the apparent under-reporting seems to indicate that this is in fact what's
going on. This sounds like a problem! Thanks a lot, dishonest hospitals!

------
danso
Really fascinating to me how some of the problem originates from the lack of
proper coding standards:

> _As examples in this article show, superbug infections are often omitted
> from death certificates. But even when they are recorded, NCHS can’t feed
> that information into vital statistics: The World Health Organization (WHO)
> classification system the agency uses lacks mortality codes for most drug-
> resistant infections, though it has codes for more than 8,000 other possible
> causes of death._

> _The CDC added codes for use in the United States for terrorism-related
> deaths a year after the Sept. 11, 2001, attacks. It could do the same for
> deaths from drug-resistant infections. Officials told Reuters the CDC is
> instead working to incorporate the codes into the WHO’s next revision of the
> international classification system. The revised system is expected to be
> completed in 2018 but not fully in use until the 2020s._

The problem of inconsistencies in death certificates have been around since,
well, the history of death certificates:
[http://www.newyorker.com/magazine/2014/04/07/final-
forms](http://www.newyorker.com/magazine/2014/04/07/final-forms)

~~~
apathy
Part of the issue is assigning "cause" (singular) of death. I'm still kind of
shocked that there isn't mandatory reporting of bacterial vectors (when
identified) the way there is for (eg) tumors. Sepsis is common enough that
positive identification of the primary strain(s) involved could be a huge
unfunded mandate, though, and judging by the way Zika is going, unfunded is
being optimistic.

~~~
danvayn
I wouldn't say sepsis is that common. More with the elderly and alcoholic
crowds, but not generally speaking

~~~
apathy
Fastest growing source of CMS billings over the past 10 years and one of the
top 20 causes of death overall. In the US, it seems that nosocomial cases are
rising faster than expected (larger proportion of the total) which is
especially worrying.

As far as the "old" crowd -- who gets sick most often?! It certainly isn't
strapping young men and women, not in any hospital I've ever been in outside
of a war zone.

------
alkonaut
This is why antibiotics use in livestock should be a top question in
international trade. Not only should every country stop using antibiotics in
healthy livestock, all _imports_ of meat and animals from such countries
should be banned, and to take it one step further - stop importing umbrellas
and calculators from those countries too, in order to apply economic pressure.

~~~
exDM69
> Not only should every country stop using antibiotics in healthy livestock

Antibiotics are not used for healthy livestock in many countries. The US is a
very notable exception.

It comes down to cutting costs. In the US, it's not typical to clean the
facilities between batches of animals like chicken. This mean that the new
batch would contract any bacteria left behind the previous animals. It's not
even that big of a cost, I'd call it borderline negligence.

I agree with you, this practice should end. Giving antibiotics to livestock at
all is harmful and it should never be done as a precautionary measure.

On smaller farms, isolating or just killing the sick animals would be fine but
that will not work in industrial scale.

~~~
daxorid
This is not the reason antibiotics are given to livestock. A wide class of
antibiotics, when delivered in subtherapeutic doses, increase feed conversion
efficiency and result in larger animals for the same feed inputs.

So yes, it's about costs, but not for the reasons you cite.

~~~
exDM69
It's not the only reason but it is _a_ reason.

But that's irrelevant, it's a cost cutting measure with harmful consequences
to the society as a whole. The regulations and producer prices should be
adjusted to make small to medium scale farming profitable and stop the
antibiotics madness.

------
codezero
My mother in law, a healthy 50 year old, recently died of an unspecified
infection. They still don't know what it was or why antibiotics weren't
helping. Ultimately, her lungs gave out after more than a week on life
support.

Was it a superbug? Dunno, and nothing in her medical record leaves any
indication that it might have been, the world just moved on.

~~~
dv_dt
There was an article a few years ago about the fall of the medical autopsy
rate. Because it's unclear how we fund it, and most people aren't in a
position of knowledge to request it (or in a financial position to pay for
it), the rates of autopsy to find a considered cause of death have been
dropping precipitously.

~~~
codezero
We shelled out for a private company for an autopsy, but post-mortem, lots of
things happen to the body that make identifying a source of an infection
really hard – basically, it didn't tell us anything new :(

~~~
dv_dt
I'm so sorry for your loss, esp. in those uncertain circumstances.

~~~
codezero
Thanks

------
ocschwar
Bear in mind that in the US, our lovely republican party literally made it
illegal to research where the superbugs are being bred.

In the US, the problem is mostly pig and cattle feedlots that rely on
antibiotics to keep the animals from being sickened but he crowding.
Naturally, there is no proof that superbugs are coming out of the feedlots,
because the feedlot owners do not allow any sort of sample collection by
scientists.

Now comes the GOP with the "ag-gag" laws, which don't just ban sneaking into
these feedlots with cameras. They also ban the smuggling of manure samples
from the feedlots.

This is the GOP's war on science: they literally criminalize it.

~~~
marcoperaza
Should someone be allowed to sneak into a company's building, or pretend to be
an honest employee, just to investigate potential wrongdoing? That's the
government's job, not private activists'.

If someone wants to walk into your private property and research your
operations, you should have the right to tell them to beat feet. If there is a
legitimate public interest then the government should create an inspection
scheme; there probably should be one but that's a separate debate. But
allowing guerilla espionage by activist groups is not an acceptable
alternative.

~~~
swasheck
There is legitimate public interest as these sites are key components of the
food production system. The point that the OP was intentionally making is that
the government (via GOP leadership, apparently) has specifically excused
itself from creating such an inspection scheme and done so in a way that seems
comprehensive enough to understand the alternative paths "guerilla ...
activist" scientists could even potentially report on such a matter.

~~~
marcoperaza
That the government is failing to investigate something cannot be a license to
trespassing or lying your way to a private investigation. If you want
government action on something, then you have to win in the political process.
Taking matters into your own hands and assuming the powers reserved for the
government is not acceptable.

===================

Replying to swashek below since I'm rate-limited: what are you talking about
"thought crime"? None of the laws here concern thought or the freedom to
publish your thoughts. They ban conducting suriptitious investigations on
farms, which necessarily involves either trespassing or deceit in gaining
access (e.g. an activist getting himself hired as an employee)

~~~
swasheck
Where do you see ANYthing about trespassing, and how do you interpret ANYthing
that either I or the OP stated as condoning it? It was simply stated that
trespassing is clearly defined as illegal. Lobbyists have cornered winning in
the political process so all we have is our voice, which it sounds like you're
trying to take away.

Even as a country of laws (which I support), you still have to be able to
admit that said laws are absurd when they are, in fact, absurd. This goes
beyond absurd and endangers the populace. You seem more interested in ensuring
that we definitively prosecute thought crimes rather than work to change the
system which, at face value, appears to place the government as accessories to
the wrongful deaths of many of its citizens (keeping focus on this particular
topic). As such, doesn't OP have the right to criticize and suspect the
government, especially when the government is ostensibly blockading one of
those "inalienable rights" of "life ..."

Keep shilling, though!

~~~
cookiecaper
This comment was fine-ish up until that last line. Please edit it away.

I don't think that the person you're replying to is suggesting that the law
should remain as-is. Rather, he's suggesting that the law should be modified
via the established political processes for doing so. I'm not sure where
you're getting the "thought crime" thing -- even if he supported the ag-gag
laws, it wouldn't be thought crime to say so, and he wouldn't be accusing
others of thought crime by saying so. This is simply called a "disagreement".
It doesn't need to be dramatized.

Of course OP has a right to criticize and suspect the government. Who said he
didn't? That doesn't mean OP has the right to disregard property boundaries or
to enter a private premises under false pretenses, even if the stated intent
is to "prove antibiotics in farm animals are causing human superbugs".

If one believes that the local trespassing laws should be modified to
accommodate persons acting in this particular public interest, he should
contact his local representatives, or, alternately, run against them and lead
the charge himself.

It is probably much easier to convince someone in one of the several
government bureaucracies to open an investigation than to get a special
exception to trespassing laws codified.

------
EGreg
This is exactly why we need open source drugs. I have written about this
extensively.

[http://magarshak.com/blog/?p=93](http://magarshak.com/blog/?p=93)

It's the flipside of the factory farm and overprescriptio fiascos. Yes, those
are bad, but we haven't discovered new types of antibiotics for decades... and
many diseases get far less attention, because of patents and silos. Even
researchers working as a result of public funding are snapped up by big pharma
once they make a discovery which then acts as a parasite on the public money.

Science progresses when anyone, anywhere, can contribute. Same with open
source. It is the reason Wikipedia is larger than and just as accurate as
Brittanica or any other encyclopedia. It is the reason Android runs on so many
phones, and Linux runs on toasters. It has given us everything from WebKit to
Wordpress and created a massive amount of solutions for the LONG TAIL instead
of just boutique drugs.

It took 30 years to discover a new antbiotic type:

[http://www.telegraph.co.uk/science/2016/03/14/first-new-
anti...](http://www.telegraph.co.uk/science/2016/03/14/first-new-antibiotic-
in-30-years-discovered-in-major-breakthroug/)

More people studying eg human bacteria in the nose will find cures if they are
unencumbered:

[http://www.nature.com/news/the-nose-knows-how-to-kill-
mrsa-1...](http://www.nature.com/news/the-nose-knows-how-to-kill-mrsa-1.20339)

We need patentleft! All that phage therapy etc. shouldn't be controlled the
way monsanto controls agriculture now.

------
webXL
This is terrifying. Perhaps we should be devoting more resources to fighting
this than ISIS since it's literally in our back yard.

It seems like this is a problem nanotech could possibly solve. Microbes won't
have much time to build up resistance if we can go after them directly.

[http://www.scientificamerican.com/article/nanotech-drug-
resi...](http://www.scientificamerican.com/article/nanotech-drug-resistant-
bacteria/)

------
fernly
The question that comes to my mind is, are the European countries doing any
better in tracking MRSA, etc. infections? They certainly exist. One might hope
a more centralized health-care system, not balkanized like the USA one[1],
would keep better records. Do they?

~~~
jkot
I think 'balkanized' is good word to describe some health-care systems in
Europe.

However I think there is a basic difference in approach. Hospitals in europe
are usually uber clean, everything is desinfected and there is a small army of
cleaners. My impression from US is that McDonnald was cleaner than hospital.

Second difference is post-operation treatment. People in weakened state are
left in hospital for a few days for monitoring. With broken immune system
(after chemotherapy) you get into strict hermetic isolation. In US leukemia
patients go to hotel after treatments.

~~~
waqf
> My impression from US is that McDonnald was cleaner than hospital.

I'm really interested in this. Where were you? Because my impression of the US
is that they are very thorough on the small stuff … because they can pass the
bill on to someone for taking precautions, whereas they can be sued for not
taking them.

~~~
ams6110
There's a reason that people get these resistant infections mostly in
hospitals.

Really, unless the alternative is death anyway, you're pretty well advised to
stay away from hospitals.

------
lgleason
My mother died from a MRSA infection after getting back surgery. It's really
nasty stuff and a very painful way for someone to die.

~~~
webXL
I'm sorry for your loss. Hopefully we as a society can devote more resources
to minimize the occurrence of this cruel disease.

------
alexmingoia
I don't know why I even read news anymore. It makes me feel hopeless when
every news story leaves me without actions I can take to change anything.

~~~
ams6110
By design. The dramatic recounting of terrible but rare diseases as if they
happen as often as sneezing keeps you reading. Eyeballs on ads == $$$ for the
publisher.

------
andrewclunn
So avoid hospitals unless absolutely needed. Gotcha.

~~~
merpnderp
Or only go to the top hospitals in the country. Comparing how the staff at a
place like MD Anderson manages sanitary conditions compared to county or state
hospitals is mind boggling.

~~~
agentgt
Even with in the same state and county it is pretty mind boggling the
differences from hospital to hospital. For example in Massachusetts where we
are known for having some of the best hospital there are still certain
hospitals in the greater Boston area to seriously avoid...

------
partycoder
Can MRSA be treated with teixobactin?

Now, E.Coli with MCR-1 is also spreading, isn't it?

~~~
nkrumm
MRSA is Staph Aureus, a gram-positive organism, and colistin is only (to my
knowledge) used in treating gram negative infections (such as e coli, which
can carry mcr-1).

MRSA can be treated with a number of different antibiotics, including
vancomycin, daptomycin, linezolid, Bactrim, and clindamycin to name a few.
Teixobactin is not yet on the market or approved for use in humans.

------
thomyorkie
Thousand-year-old Anglo-Saxon potion kills MRSA superbug:
[http://www.cnn.com/2015/03/31/health/anglo-saxon-potion-
mrsa...](http://www.cnn.com/2015/03/31/health/anglo-saxon-potion-mrsa/)

------
clumsysmurf
Its our pets too ...

My dog was recently diagnosed with MRSP (methicillin-resistant Staphylococcus
pseudintermedius) urinary track infection.

Having mostly avoided the vet for the duration of his life (being that he was
healthy) I have no idea how this happened.

------
dghughes
This is almost like going all the way back to Dr. Semmelweis who figured out
that you keep hospitals clean or people will die.

Even long sleeves can be the enemy.

I know superbugs are different but the concept is the same.

------
wehadfun
I would vote for a politician that talked about this issue.

------
jcromartie
But our gov't is right on top of banning even more harmless plants... (Kratom
this time).

------
esaym
I skimmed the article, I only saw mention of MRSA. Is that the "super bug"
they talk about? This is for the most part why I won't step foot in a hospital
unless I am literally on my death bed. The last research I read about MRSA
(years ago) was it was hard to study because lab rats could not be easily
infected with it unless it was directly injected into their blood stream. This
shows just how nasty hospitals are. Nobody gets MRSA unless they are in the
hospital.

~~~
DanBC
> Nobody gets MRSA unless they are in the hospital.

You might want to read about Community Acquired MRSA.

[http://www.phac-aspc.gc.ca/id-mi/camrsa-eng.php](http://www.phac-
aspc.gc.ca/id-mi/camrsa-eng.php)

[http://wwwnc.cdc.gov/eid/article/8/6/01-0313_article](http://wwwnc.cdc.gov/eid/article/8/6/01-0313_article)

> To estimate the proportion of community-acquired MRSA, we analyzed previous
> hospitalizations for all MRSA-positive persons in Finland from1997 to 1999
> by using data from the National Hospital Discharge Register. Of 526 MRSA-
> positive persons, 21% had community-acquired MRSA.

~~~
brightsize
My brother got exactly this, presumably from swimming in the ocean during a
vacation in the Philippines. I speculate that there was sewage being released
into the sea somewhere not far from where he was staying. He lived, but the
infection site was pretty nasty to behold.

