Superbugs’ hidden toll

Source:Reuters Published: 2016/11/20 20:18:39

Authorities hiding risk as infections earn billions

Zachary Rubin, medical director of clinical epidemiology and infection prevention at the Ronald Reagan UCLA Medical Center, takes questions from the media in Los Angeles in Feburary 2015. Los Angeles County health officials say a

Zachary Rubin, medical director of clinical epidemiology and infection prevention at the Ronald Reagan UCLA Medical Center, takes questions from the media in Los Angeles in Feburary 2015. Los Angeles County health officials say a "superbug" bacterial outbreak at a local hospital doesn't pose any threat to public health. Photo: IC

With good reason, Dan Greulich's doctors called him "the miracle man."

After Greulich's second combined liver-and-kidney transplant in early 2012, his wife, Rae, sent a letter to the donor's family. "You not only saved a man," she wrote, "you saved a family."

But then, less than three weeks into his recovery at Los Angeles Medical Center of University of California, Greulich contracted an antibiotic-resistant infection - a common and often lethal hazard of hospital stays. Over the next five months, according to thousands of pages of medical and billing records, Greulich was attacked by no fewer than half a dozen different "superbugs," most of them strains that are encountered almost exclusively in healthcare facilities.

Greulich's immune system, suppressed by medications to prevent organ rejection, had no way to fight the bacteria. When the usual antibiotics failed to snuff them, he was pumped full of powerful alternatives, sometimes as many as half a dozen a day. Some had alarming side effects - hearing loss, severe pain, nausea. The infections kept coming.

Sepsis, a dangerous inflammatory response to infection, set in. Confined to an intensive care unit (ICU), Greulich was frequently placed on mechanical ventilation, itself a common source of infection. He wavered in and out of consciousness. Doctors cut him open again to seek the source of the problem. At one point, they considered putting him back on the transplant list, but only if they could clear him of infection.

They couldn't. On June 30, 2012, Greulich died, age 64.

Data not tracked

Dan Greulich is one of the uncounted - the tens of thousands of people in the US whose infections and deaths by superbug are not tracked by public health agencies.

Deaths like Greulich's speak to the high human toll of superbugs. But Greulich's death and, in particular, the effort to prevent it also speak to the enormous waste caused by the infections: two precious organs in a country where 22 people die every day waiting for one; thousands of hours put in by dozens of doctors, nurses and other medical workers to save a life; and big sums of money spent on drugs, surgery and hospital care, contributing to the billions of dollars superbugs add to the US healthcare bill every year.

Too many other variables are at play. However, at $5.7 million, the charges for Greulich's seven-month hospitalization were nearly five times what the National Foundation for Transplants says are the average first-year charges for a liver-and-kidney transplant.

Reuters undertook its own analysis to get an idea of how much superbug infections cost. Using national inpatient data from the federal Agency for Healthcare Research and Quality for 2013, the analysis of millions of records focused on infections from two superbugs: methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile.

It found that an infection can add thousands of dollars to the cost of a patient's hospital stay. The average MRSA infection added about $11,000 per inpatient stay, while  C. difficile added about $5,200.

Public foots bill

Most superbug infections are contracted in hospitals and other medical facilities. The big bills that result are most often covered by health insurers and other third-party payers. This means that ultimately, the costs are passed to consumers in the form of higher insurance premiums, said David Cutler, a Harvard University economist who specializes in healthcare. "There is no other way to do it," he said.

Private insurers generally do not deny reimbursement for treatment related to superbug infections. Even in cases where hospitals are held legally liable for the infections, they are often shielded from eating the full cost.

The Centers for Medicare & Medicaid Services (CMS) penalizes hospitals for high infection rates by reducing payments from the huge Medicare government health-insurance program for the elderly. And the agency does not pay the added costs of some types of preventable infections, such as catheter-associated urinary tract infections, if they are contracted in the hospital.

Modern medical advances sustain life for people who would otherwise die. But they come at a cost.

Dan Greulich was the perfect target. Rae said she repeatedly asked nurses about Dan's post-operative drains. They told her only that he had a fungal infection, she said. No one told her the names of the pathogens, or that they were resistant to multiple drugs, or how dangerous they were.


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