The recent outbreaks of "superbug" infections at two Los Angeles hospitals have thrown a spotlight on the fact that California does not require medical facilities to report all forms of this infection. An L.A. congressman says he will introduce legislation to mandate full reporting nationwide.
Carbapenem-resistant Enterobacteriaceae, known as CRE, broke out at Ronald Reagan UCLA Medical Center last month; Cedars Sinai Medical Center also had cases of the superbug, as have hospitals across the country in recent years.
Six months ago, President Obama issued an executive order that said combatting superbugs is a national security priority. The head of the Centers for Disease Control and Prevention has called CRE a "nightmare bacteria."
"There is no way to cure CRE, half of the people who get it die from it," notes Nancy Hailpern, who tracks federal policy for the Association for Professionals in Infection Control and Epidemiology. "It's resistant to the last resort antibiotic."
The CDC says it's up to the states to decide which CRE infections hospitals must report. There are now 20 states that require hospitals to report all superbug infections.
California is not one of them.
The state does require hospitals to report CRE if it’s contracted through a central line or a surgical site. But they don’t have to report it if it’s transmitted through an endoscope, which is what happened at Cedars and UCLA.
That bothers U.S. Rep. Ted Lieu (D-Los Angeles).
"I am mystified at how we can have this whole focus on fighting superbugs, when the White House issued its executive order, and have such huge gaps in reporting," he says.
The California Department of Public Health said in an exchange of emails that neither it nor the CDC requires comprehensive reporting because, basically, it's too complicated. The state agency says there are different strains of CRE and no consensus definition of what it is.
And there's another layer of complexity in trying to come up with reporting requirements, according to Marcia Patrick, an expert in infection prevention.
"Often with these multidrug-resistant organism[s], patients may become colonized with them but not get infected," she points out. "And so do you just report the infections or do you report the presence of the organism even if it isn't causing an infection - or do you wait to see if it's going to cause an infection. It's just not simple black and white."
But Congressman Lieu is determined to push for tougher reporting requirements, noting that CRE can be passed on by contact with bodily fluids and its high mortality rate.
"You can't fight superbugs and fight against antibiotic resistant bacteria if we don't even know the scope of the problem," argues Lieu, who represents the district that includes both UCLA and Cedars.
"I'm working on legislation right now to require national mandatory reporting of CRE outbreaks whenever it happens in any hospital regardless of what state they happen to be located in," he says. "It will be reporting to the CDC, and if the outbreak happened as a result of a medical device they would also have to report to the FDA as well."
Lieu says he plans to introduce his bill within the next two months.
The congressman is also leading an effort to hold the FDA accountable for the outbreaks related to the duodenoscopes that were tied to the outbreaks at UCLA and Cedars. He and several other congressmembers sent a letter to the FDA asking for answers about when the agency knew there was a problem and what it is doing to fix it.