USA — Defense Department Responds to ‘Superbug’ Threat

WASHINGTON — The mil­i­tary has been a leader in rec­og­niz­ing and pro­tect­ing against the spread of mul­tidrug-resis­tant organ­isms, com­mon­ly known as “super­bugs,” defense offi­cials told Con­gress mem­bers yes­ter­day.

This strain of antibiotic-resistant Staphylococcus aureus bacteria is magnified 50,000 times
This strain of antibi­ot­ic-resis­tant Staphy­lo­coc­cus aureus bac­te­ria is mag­ni­fied 50,000 times.
CDC pho­to by Dr. Matthew J. Arduino
Click to enlarge

DOD has been active­ly engaged in mea­sures to screen, sur­veil, pre­vent and con­trol infec­tion in mil­i­tary treat­ment facil­i­ties at home and on the bat­tle­field,” Dr. Jack Smith told a House sub­com­mit­tee yes­ter­day. Smith is the act­ing deputy assis­tant sec­re­tary for clin­i­cal and pro­gram pol­i­cy in the Office of the Assis­tant Sec­re­tary of Defense for Health Affairs.

Super­bugs can cause infec­tions any­where but are espe­cial­ly dan­ger­ous when they arise and spread among hos­pi­tal patients, Smith said.

In hos­pi­tal set­tings, the infec­tions are most like­ly to con­t­a­m­i­nate sur­faces and equip­ment like ven­ti­la­tors and dial­y­sis machines; the hands of health care work­ers, vis­i­tors and fam­i­ly mem­bers; and the res­pi­ra­to­ry, uri­nary, skin and gas­troin­testi­nal tracts and wounds of hos­pi­tal­ized patients, he said.

“Health care-asso­ci­at­ed infec­tions, includ­ing those from mul­tidrug-resis­tant organ­isms, are a seri­ous prob­lem for the mil­i­tary and rep­re­sent a grow­ing prob­lem in health-care facil­i­ties across the nation,” Smith added. “These dis­ease-caus­ing organ­isms that are pre­dom­i­nant­ly bac­te­ria have increased the length of hos­pi­tal stays and mor­tal­i­ty rates.” Drug Resis­tance: A Grow­ing Threat

Drug resis­tance is the abil­i­ty of some microor­gan­isms to with­stand attack by antimi­cro­bials, includ­ing antibi­otics, accord­ing to the World Health Orga­ni­za­tion. It can come from the overuse and mis­use of antibi­otics and from the spread of resis­tant strains among peo­ple, in com­mu­ni­ties and across coun­tries.

Accord­ing to the U.S. Cen­ters for Dis­ease Con­trol and Pre­ven­tion, some com­mon drug-resis­tant organ­isms include:

— Methi­cillin-resis­tant Staphy­lo­coc­cus aureus, called MRSA, is a kind of bac­te­ria that’s resis­tant to methi­cillin, peni­cillin and oth­er antibi­otics. It was first rec­og­nized in the 1960s and now is a grow­ing prob­lem in health-care facil­i­ties and in com­mu­ni­ties.

— Van­comycin-resis­tant ente­ro­coc­ci, called VRE, are bac­te­ria present in the human intes­tine. Resis­tance devel­oped because of the mis­use of antibi­otics like van­comycin and the strain can spread from per­son to per­son.

— Mul­tidrug-resis­tant Mycobac­teri­um tuber­cu­lo­sis, called MDR-TB, is an infec­tious bac­te­r­i­al strain that arose from improp­er use of first-line or stan­dard anti-TB drugs. Exten­sive­ly drug-resis­tant (XDR-) TB aris­es when sec­ond-line or less-effec­tive TB drugs are mis­used, WHO says, cre­at­ing a strain for which treat­ment options are seri­ous­ly lim­it­ed.

“The Infec­tious Dis­ease Soci­ety of Amer­i­ca, the Insti­tute of Med­i­cine and the World Health Orga­ni­za­tion all have iden­ti­fied resis­tant infec­tious agents as major pub­lic health threats for which a coor­di­nat­ed glob­al effort is urgent­ly need­ed,” said Navy Capt. (Dr.) Gre­go­ry Mar­tin, the Navy sur­geon general’s spe­cial­ty leader for infec­tious dis­eases and a prac­tic­ing infec­tious dis­ease physi­cian at Bethes­da Naval Hos­pi­tal in Mary­land.

Health pro­fes­sion­als and researchers are con­cerned that if bac­te­ria devel­op resis­tance to all antibi­otics, health offi­cials say, no treat­ment options will exist for infect­ed patients.

Mul­tidrug-resis­tant infec­tions in com­bat injured were first iden­ti­fied in 2003, Mar­tin said, on the hos­pi­tal ship Com­fort and at Bethes­da Naval Hos­pi­tal.

Mil­i­tary Efforts

Smith said mil­i­tary health sys­tem efforts include a qual­i­ty assur­ance pro­gram imple­ment­ed in all mil­i­tary treat­ment facil­i­ties that estab­lish­es poli­cies, pro­ce­dures and train­ing pro­grams to min­i­mize reduce the risk of infec­tion to patients and staff. In fis­cal 2010, DOD spent $13.6 mil­lion on these efforts.

“We’ve estab­lished an infec­tion pre­ven­tion and con­trol pan­el with ser­vice sub­ject-mat­ter experts as a sub­com­mit­tee of our mil­i­tary health sys­tem qual­i­ty forum,” he said, and the Defense Department’s Glob­al Emerg­ing Infec­tion Sur­veil­lance and Response Sys­tem gath­ers data from par­tic­i­pat­ing mil­i­tary lab­o­ra­to­ries and hos­pi­tals world­wide to mon­i­tor poten­tial dis­ease out­breaks.

The sur­veil­lance sys­tem, estab­lished by pres­i­den­tial direc­tive in 1996, is a net­work of U.S. and over­seas lab­o­ra­to­ries whose work helps the mil­i­tary health sys­tem pre­vent, mon­i­tor and respond to infec­tious dis­eases that threat­en mil­i­tary per­son­nel and fam­i­lies and U.S. nation­al secu­ri­ty.

In the Unit­ed States, the DOD sur­veil­lance sys­tem includes the Army Cen­ter for Health Pro­mo­tion and Pre­ven­tive Med­i­cine and the Army Med­ical Research Insti­tute of Infec­tious Dis­eases in Mary­land, the Naval Health Research Cen­ter in Cal­i­for­nia, the Naval Envi­ron­men­tal Health Cen­ter in Vir­ginia and the Air Force Glob­al Sur­veil­lance Office in Texas.

The sys­tem has estab­lished work­ing rela­tion­ships with the CDC and inter­na­tion­al health agen­cies, includ­ing WHO. Over­seas, mil­i­tary lab­o­ra­to­ries in Egypt, Indone­sia, Kenya, Peru and Thai­land work with each country’s health min­istry — and some­times mil­i­taries — on dis­ease research and sur­veil­lance.

Since Decem­ber 2008, 33 mil­i­tary treat­ment facil­i­ties have par­tic­i­pat­ed in CDC’s Nation­al Health Care Safe­ty Net­work, a vol­un­tary, secure, Inter­net-based sur­veil­lance sys­tem that inte­grates patient and health-care per­son­nel safe­ty sur­veil­lance sys­tems man­aged by CDC.

DOD has also part­nered with the Vet­er­ans Admin­is­tra­tion and the CDC to address the chal­lenge of drug-resis­tant organ­isms.

“The DOD,” Mar­tin said, “has been a nation­al leader in iden­ti­fy­ing and address­ing the [mul­tidrug-resis­tant organ­ism] chal­lenge.”

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)

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