New York Identifies Hospitals and Nursing Homes With Deadly Fungus – The New York Times
Nearly 35,000 people in the United States are dying each year from drug-resistant infections, public health officials said on Wednesday, an alarming problem that New York state underscored by revealing that it had found one particularly new and virulent fungus in 64 hospitals and 103 nursing homes.
The numbers show just how widespread drug resistant infections have become, with the latest projection of deaths in America double previous estimates.
“A lot of progress has been made but the bottom line is that antimicrobial resistance is worse than we previously thought,” said Michael Craig, the senior adviser on antibiotic resistance for the Centers for Disease Control and Prevention, which released the updated death toll on Wednesday. “Every 11 seconds someone in the United States gets a resistant infection and someone dies every 15 minutes.”
The C.D.C. report came on the same day that New York became the first state to release the names of the medical facilities that have treated patients with Candida auris, a fungus that is resistant to major medicines and has been spreading globally under a cloak of secrecy.
C. auris is one of the newer and more mysterious examples of such infections. The New York Times has spent the past year documenting its rise as multiple governments declined to identify or confirm the names of hospitals and nursing homes with the presence of C. auris. Some hospitals, including major academic institutions, declined to discuss cases even when family members or physicians confirmed them.
New York health officials said they decided to break with that practice and disclose the names of the institutions with cases in the state over the past three years because of how rapidly C. auris has spread. Their aim, they said, was to provide transparency to consumers and encourage hospitals and nursing homes to help stop its spread.
The state found that the heaviest concentration of C. auris patients was in Manhattan, Brooklyn and Queens. It did not say how many cases were at each institution and or identify patients.
The new C.D.C. report, a comprehensive look at the nation’s battle against antimicrobial resistance, said that 2.8 million people are sickened each year in the United States from pathogens that have learned to outsmart antimicrobial drugs, an increase of 800,000 per year since the previous report was issued in 2013. Officials said the updated figures reflected advances in data collection made possible by electronic medical records.
The findings were not entirely dire. The agency documented a 30 percent decline in deaths among patients who acquire drug-resistant infections in hospitals, a reduction it attributed to better hygiene among nurses and doctors who in recent years have been bombarded with messages about the importance of hand washing.
Among the greatest threats the report cites are a form of drug-resistant gonorrhea that has been spreading among young people and gay men, tough-to-treat urinary tract infections that strike otherwise healthy women, and Clostridioides difficile, or C. diff, a deadly bacterial infection that ravages the guts of hospitalized patients, sickening 224,000 and killing 12,800 each year.
On the flip side, the C.D.C. reported substantial declines in cases of MRSA, a bacterial infection sometimes referred to as a “superbug” and infections like Pseudomonas aeruginosa, an infection that often strikes nursing home residents on ventilators and patients recovering from surgery.
The C. auris cases identified in New York on Wednesday included patients who were infected and those who are “colonized,” which means they have it on their skin but are not showing symptoms. Some colonized patients eventually become ill and some do not, but all have the potential to spread the germ. The state also listed several cases of patients believed to be
The germ, which is typically resistant to one or more major antifungal medications, preys on people with compromised immune systems, and spreads with ease on equipment, clothing and skin.
About half of patients who contract C. auris die within 90 days, although the patients are typically infirm and so it is not clear whether they die from the fungus or it merely is among an ultimately lethal combination of poor health factors. There have been 806 confirmed cases of C. auris infection in the United States; 388 are in New York.
In releasing the hospital and nursing home data, New York State officials implored patients not to avoid going to medical facilities just because they have treated C. auris patients. In fact, the hospitals and nursing homes listed may well be doing a good job of containing the fungus, said Dr. Howard Zucker, the commissioner of the New York State Department of Health.
At the same time, he said the germ has spread so quickly that hospitals and nursing homes need to acknowledge its presence and address it as they would other major drug-resistant infections tracked and made public by the state. Consumers, he argued, deserve to know “to help them make an educated decision for their life or someone dear to them.”
For hospitals and nursing homes, he said, there was a benefit, too. “If you can’t measure it, you can’t improve it,” he said.
New York is the first state to provide such data, said Michael Osterholm, the director for infectious disease research and policy at the University of Minnesota, where he runs a clearinghouse for information on drug-resistant infection.
“One of the challenges we’ve had is this climate of secrecy,” he said. “I applaud this,” he added. “It’s potentially a game changer because of the unique nature and consequences of dealing with this infection.”
The reports from the C.D.C. and New York, which also found improvements in hospital performance at the state level in dealing with drug-resistant infections, suggest that intensified scrutiny is making at least modest inroads into a worldwide challenge.
Drug resistance is a vexing, seemingly intractable problem owing to the powerful forces driving it: the biological reality that germs will develop defenses when threatened with extinction and modern medical, pharmaceutical and farming economies are built on the use of millions of tons of antibiotics and antifungal drugs.
Without change, the United Nations estimates that drug-resistant infections will kill 10 million people in the year 2050, more than the number projected to die that year from cancer.
C. auris has become an object lesson in many of the core policy debates and challenges, and that includes discussion about whether to disclose health care institutions that are battling the germ.
Loretta Willis, vice president for quality advocacy with the Healthcare Association of New York, which represents about 100 nursing homes in the state, said she worried New York’s disclosure could unnerve patients and their families. “Without a fuller understanding about what’s happening and what’s going on with these emerging infections, it may cause unnecessary panic,” she said.
“I’m worried it will be taken out of context,” said Ms. Willis, who is also a nurse, asserting that there are many germs these institutions deal with, that they are equipped to handle the situation and that it would be to the detriment of patients and their families to look at a list of facilities and say, “‘That’s horrible, I’ll never go there.’”
Brian Conway, a spokesman for the Greater New York Hospital Association, said, “While we have some reservations about hospitals being named, the hospital community is committed to doing everything we can to eliminate C. auris.”
He added that this week the group is releasing a five-minute training video for hospital and nursing cleaning crews about how to clean a room where a patient has tested positive for C auris. New York City, a major travel hub, can be among the first to face new germs and be forced to consider new policy positions.
But C. auris is growing elsewhere with institutions treating it still unknown.
California confirmed this week that the number of colonized patients has jumped in Southern California — from fewer than five this summer to 181. But California health officials declined to be interviewed by phone about the subject and responded in an email, “The California Department of Public Health (CDPH) is in the process of determining if facility names can be released.”
The state of Connecticut declined earlier this year to identify the hospital where one of the first C. auris patients was detected in the United States; a hospital in Chicago, Northwestern Memorial Hospital, also would not comment or provide any acknowledgment of the situation for an article that was published about a patient with C. auris who had died; doctors at several institutions around the world told The New York Times they could not speak about the patients they had seen or the spread of C. auris at hospitals where they worked, fearing reprisals from administration.
Dr. Zucker, the New York State health commissioner, said he hoped that other states would follow New York’s lead.
“We really live in an information-centric world and patients should have data,” he said.
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