Public Health Emergency - Leading a Nation Prepared
Author: Rick Bright, Ph.D., BARDA Director and Deputy Assistant Secretary for Preparedness and Response Published Date: 12/17/2019 1:53:00 PM
Category: National Health Security; Medical Countermeasures; Hospital Preparedness;
Although a range of health security threats - from bad actors to new infectious diseases - loom and are always emerging, I fell victim to a threat in my own backyard: an antibiotic resistant infection. To complicate matters, I couldn’t get an accurate diagnosis until it was almost too late. But the delayed diagnosis didn’t just threaten my health – it also added to healthcare costs, led to the misguided use of antibiotics, and potentially threatened the health of other patients in a hospital.
Last year, I cut my thumb while gardening. At first, I didn’t think much about nicking my finger on a plant. Then the spot turned into a white pimple-size bump; within a day, a red flush began creeping up my hand. One of my colleagues, an infectious disease physician, spotted the infection and recommended that I get medical care quickly. That was great advice – but I didn’t take it. Instead, I went about my day. I attended a hearing before Congress, met with my staff and others, reviewed materials, and worked late.
As the sun set, that physician checked in on me. Frustrated, he made it very clear that if I did not get care immediately, I might not be able to the next day…the infection was spreading and could get much worse quickly.
I left and, hoping to avoid long wait times in hospital emergency rooms, I tried going to an urgent care clinic for help. The first two clinics were unable to help me – the first indicated that my case may require more complex treatment than her clinic can offer and the second was closing in 45 minutes and couldn’t take any more patients. At the third urgent care center, a doctor took a quick look, said I had some kind of infection, prescribed a common generic antibiotic, and offered to check the wound again in five days. After several minutes of my pleading and insistence that she lance and culture the wound, she agreed. She wrapped my hand and sent me home.
The next day, my hand looked worse and the redness was spreading. I saw my primary physician who immediately referred me to an orthopedic surgeon, who promptly sent me to the hospital, where I received pain meds and an IV antibiotic. The orthopedic’s team cut into the wound to better examine it, and then packed it and prescribed another antibiotic (now, the third). He advised me follow up with my doctor in a couple of days.
But the wound only got worse. I snapped some photos and sent them to some my infectious disease co-worker to ask if this was normal. Unfortunately, he answered no and he recommended I get back to the emergency room immediately.
Back in the hospital, I received two more antibiotics plus an antifungal for extra caution. The orthopedic experts determined that I needed to spend the night in the ER and plan for surgery that would include slicing open my hand for deep treatment or possibly removing my thumb.
None of the drugs were working, and we had no information from a diagnostic! The doctors had to shoot in the dark. My primary physician placed an angry call to the ER to demand an infectious disease consultation. After hours, an infectious disease doctor stopped by for a few minutes, changed the antibiotic (my sixth), and recommended that the planned surgery proceed.
I was moved to the hospital’s orthopedic unit, with dozens of elderly patients around me waiting for hip and knee replacement surgeries the next day. In what would become my home for the week, I was switched to yet another antibiotic, kept on three of the others and the antifungal, and fasted for surgery.
At 4 a.m., an orthopedic resident awoke me for surgery prep. Next came a quick check from the infectious disease doc and then a deep pause…she said it didn’t look worse today; in fact, it might even look a little better. We delayed the surgery a day to watch for continued improvement. Something, one of the four drugs going into my veins was working (or was it the antifungal?).
Six days after the urgent care clinic took culture, they received the results; however, they had to wait another day to get the appropriate staff to “interpret” the results, and they were not allowed to tell me or my doctor or even email or text a photo of the results. The only way they could share the results was in person or a fax machine. Technology from the late-1800s stood between me and informed treatment for a garden cut.
The test results clearly indicated MRSA. After nearly a week in the hospital, freely roaming the orthopedic surgery unit among potentially vulnerable patients, I knew the nurses finally got my results because they hung a sign on my door and started wearing gloves when they came into my room. The sad part of the story was that it still took another day to get the antibiotic sensitivity test results to the hospital. Only one of the drugs I was on was working; the other three were just burning my veins and potentially driving more resistance.
These results informed the length of my hospital stay and options for home treatment. The options were a disheartening: leave an IV line in my body for daily home drug infusions by a nurse or transition to a newer, expensive class of oral drugs my insurance may not cover. I chose the oral medication, which became my seventh antibiotic in two weeks, and suffered hearing, vision, concentration and muscle complications for the following two weeks. But, I kept my thumb!
Imagine how much faster the best treatment could have been determined and administered if the clinic, the ER or the hospital had a rapid diagnostic which could have told me and the doctor what the infection was and which medication would work best. I could have completely avoided unnecessary antibiotics (which helps reduce antibiotic resistance) and the hospital stay, saving money and time, and recovering faster – without mentally preparing to lose my thumb. And don’t forget the hundreds of vulnerable, high-risk people in the hospital I may have exposed to my MRSA infection while awaiting test results.
The gardening incident gave me personal insight into the many challenges that confront medical professionals and every patient fighting a resistant infection. I am more committed than ever to overcoming this challenge, to identifying solutions, and to partnering with private sector to get ahead of antimicrobial resistant infections and protect our nation’s health security. I hope more potential industry partners will look closely at the problem and join me by partnering through programs like CARB-X, BARDA DRIVe and other BARDA-supported initiatives.
To find out more, stay tuned for next week’s blog, which will focus on the research and development of innovative new diagnostic tests to inform patient care and fight antibiotic resistance.
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