By Dr. David Scales
You may have heard about Daniel Fells, the tight end on the New York Giants who almost lost his foot due to a drug-resistant infection. You’ve heard about drug resistant infections like Fells’ because dire reports about “the end of antibiotics” are all over, but maybe you want to know if resistant germs are common near you.
Unfortunately, you’re out of luck. While your hospital probably collects that data, they probably won’t share it with you.
John Brownstein, an associate professor at Harvard Medical School, and his colleagues at Boston Children’s Hospital (the group responsible for HealthMap.org), are working to make these data more available. They are tracking resistant bacteria through an online map called ResistanceOpen. The goal is to shed light on how much resistant bacteria is in your area and which antibiotics those bacteria are resistant to. (Full disclosure: I did my post-doc with HealthMap, leaving in 2013.)
Other groups track drug-resistant bacteria — like ResistanceMap put out by the Center for Disease Dynamics, Economics and Policy, based in Washington, D.C. — but it’s never been done at such a local level. ResistanceOpen provides data and information on four of the most dangerous types of resistant bacteria, including MRSA, the infection that Fells caught in his foot.
It’s not yet so detailed where you can get data on your local hospital, but currently you can search for information on which drug-resistant bugs are circulating in a 25-mile radius from your location, or any other location you choose. The hope is that if people know which resistant germs are in their area, it’ll help draw attention to the issue. One day, ResistanceOpen hopes to map data at the hospital level.
“I feel like antimicrobial resistance should be treated with the same urgency that other communicable diseases are met with and I believe it has to start with transparency and awareness,” Dr. Derek MacFadden, a Canadian infectious disease doctor who worked on the project, told HealthMap’s Disease Daily. “ResistanceOpen provides the public with both.”
While some of the data for the map comes from news reports about resistant bacteria, Dr. MacFadden, who is also a doctoral student at Harvard T.H. Chan School of Public Health, found much of the data for ResistanceOpen by scouring hospitals’ websites.
Hospitals routinely track antibiotic resistance on their wards and in their clinics. With that data they usually create a yearly “antibiogram” — a catalogue of bacteria found in patients treated at that hospital in the past year. Antibiograms help guide physicians at that hospital on how to treat patients by avoiding antibiotics that are unlikely to work. But antibiograms are not always public, so only the physicians (and patients) at that hospital benefit from the information.
It sounds simple, but sometimes what sounds simple is innovative. “The power of collecting data in these new ways is it provides insight on information that would otherwise be behind closed doors,” Dr. Brownstein said.
Hospitals keep these data under wraps because they’re worried people won’t want to come to their hospital if there are high rates of resistant bugs. Would you get your knee surgery at a hospital with the highest rate of resistant germs?
Well, actually, you might. High rates of resistance might reflect that a hospital treats the sickest, most complicated patients. So even if they do everything right, sometimes hospitals have high rates of drug-resistant infections because they’re taking care people with cancer on chemotherapy or after getting transplants. Hospitals don’t want to get penalized simply because they’re treating the sickest. “Nobody wants to be known as the hospital with the most antibiotic resistance,” Dr. Larry Madoff, director of the Division of Epidemiology and Immunization at the Massachusetts Department of Public Health, told me.
The Department of Public Health collects data on resistant bacteria in the state through their antibiotic stewardship program. While transparency is a goal of the DPH, according to its interim director of communications, Scott Zoback, it doesn’t yet publicly release antibiotic resistance data. As they deal with over 300 data streams, releasing raw data could cause more confusion than clarification, he said. Also releasing the data might make hospitals less willing to share in the future — on drug resistant bacteria and beyond. “Anybody is more prone to share data in a confidential way,” Dr. Madoff said. “A lot of public health is done in private.”
Still, more transparency is needed. While Massachusetts is a step ahead by even collecting the data, other states in New England don’t collect these data. Hospitals in those states aren’t required to report their antibiograms to anyone, not even to share them with each other.
Here’s where HealthMap’s efforts come in. Collecting data in non-traditional ways seems to work best when traditional public health efforts fail. HealthMap was out in front of the ebola epidemic in 2013, reporting on the outbreak more than a week before the World Health Organization released its information.
Earlier this month, reports disclosed that a new superbug (part of the family of bacteria known as CRE) is on the rise in the U.S. It’s one of the germs resistant to most antibiotics, and it’s also actively tracked by ResistanceOpen.
And there are other germs looming. For instance, another recent report noted that a bacteria in China was found to be resistant to the antibiotic of last resort: colistin.
You’ve probably never heard of colistin — nor ever gotten it to treat a strep throat, urinary tract infection or ear infection. That’s because it has a lot of side effects. It was discovered in the 1940s and found to cause problems with kidney function — usually reversible — but it fell out of use once safer antibiotics came around.
But precisely because it’s used infrequently, bacteria are usually susceptible to it. So the superbugs we hear about — the ones that are resistant to almost all antibiotics — can still usually be treated with colistin.
We knew these bugs were coming because colistin has been used to help pigs and other livestock put on weight more quickly. Since it was developed so long ago, it’s cheap and easy to get.
There’s been colistin resistance before, but this time is different. Previously, the resistance was more of a chance mutation — something that happened once but couldn’t be spread to other bacteria to make them resistant too. The report, which appeared in the journal The Lancet Infectious Disease, showed that now the gene that creates the resistance is being transferred from bacteria to bacteria on a plasmid, a circular piece of DNA that can be shared between species.
That means not only is colistin resistance a big issue, but now it is likely to spread quickly. While it hasn’t yet reached the United States, ResistanceOpen will be one place to watch to find out when it does. In the meantime, there are lots of other resistant germs in your area to keep watch on.