She lived independently in Lockport, managed her own finances, drove a car and maintained an active social schedule. Her daughter, Mary Brennan-Taylor, likes to show a photograph of her mother dancing at a family wedding last year.
"She had the spirit of an 18-year-old," said Brennan-Taylor.
But Alice Brennan's right leg began to experience pain and swelling in 2009. She was hospitalized briefly, diagnosed with gout and sent to a nursing home for rehabilitation.
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Instead of recuperating from the severe form of arthritis, she deteriorated and died six weeks after the initial hospitalization. Her family contends three infections that Brennan developed led to her death.
"What's most difficult for me is that this was preventable," said Brennan-Taylor.
Brennan's story illustrates a major challenge in health care. It was once believed that antibiotics would erase bacterial infections. Instead, overuse and misuse of the drugs in medicine and on farms is making treatment of infections more difficult as germs evolve with growing resistance.
An estimated 99,000 deaths associated with infections occur in hospitals alone each year, according to the federal Centers for Disease Control and Prevention. In recent decades, infections became so common that they were considered an unavoidable complication of caring for the sickest patients. Yet many are avoidable.
"We assume that infections are natural, that they emerge out of nowhere because they often occur in people who are already ill. But infections are transmitted. That means they can be prevented and these deaths reduced," said Ramanan Laxminarayan, the lead investigator for Extending the Cure, a project examining antibiotic resistance based at Resources for the Future, a think tank in Washington, D.C.
Earlier this year, for instance, a project at more than 100 Michigan intensive-care units reported a 66 percent drop in bloodstream infections from the placement of catheters in veins after adopting a checklist of infection-control practices, including hand-washing, and measuring the results.
But potentially fatal infections like the ones linked to Brennan's death persist despite the existence of measures to limit the spread of microbes.
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In its 2009 quality report to Congress released last month, the Health and Human Services Department found "very little progress" on eliminating health care-acquired infections.
Among five major infections examined, the rate of bloodstream illness following surgery increased 8 percent from 2006 to 2007, while the rate of post-operative urinary tract infections from catheters rose 3.6 percent.
There is debate over the quality report's conclusion about progress that forthcoming government studies may clarify. But there is little disagreement over the problem of antibiotic resistance and the specter of making once-treatable diseases untreatable, as if the era before antibiotics had returned.
"If we use antibiotics more appropriately we will improve our ability to treat bacterial infections, and if we do a better job of infection control, we will reduce the need for antibiotics," said Laxminarayan.
In a recent study, he and his colleagues found that two common hospital-acquired infections -- pneumonia and sepsis, a bloodstream illness -- killed 48,000 people and increased health costs by $8.1 billion in 2006 alone. The research looked at deaths actually caused by infections, whereas the CDC statistic of 99,000 refers to deaths associated with hospital-acquired infections.
Laxminarayan said solutions to the problem will require stronger government leadership to develop new antibiotics, better treatment strategies and community infection-control efforts that go beyond hospitals.
Brennan's case illustrates how patients and microbes today travel from facility to facility.
She was discharged July 17 from Eastern Niagara Hospital (formerly Lockport Memorial) to the Odd Fellows & Rebekah Rehabilitation and Health Care Center in Lockport for what was supposed to be two weeks of therapy to help with walking.
However, she began to suffer from hallucinations, incontinence and loss of appetite, symptoms her daughter contends resulted from a high dose of a muscle relaxant.
Brennan was readmitted Aug. 3 to Eastern Niagara with dehydration and a few days later sent back to Odd Fellows, where symptoms worsened and grew to include abdominal pain, according to Brennan-Taylor.
She returned to the hospital around Aug. 10 with a urinary tract infection caused by MRSA, a bacterium resistant to common antibiotics, said Brennan-Taylor. Her mother was treated with another antibiotic, vancomycin, but continued to decline. Then tests identified two more bacterial infections -- clostridium difficile, which causes diarrhea, and vancomycin-resistant enterococci, which can cause skin wounds.
"My mom fell prey to a fragmented health system and a complacent attitude about infections," said Brennan-Taylor. "People in health care act as if infections are inevitable, or that this happens all the time, and they can turn it around. It shouldn't be something they deal with all the time."
A state Health Department investigation faulted the hospital for not implementing an adequate care plan for isolating the patient. A review of Odd Fellows found no evidence to corroborate Brennan-Taylor's complaint of inadequate care.
Hospital and nursing home officials declined to discuss the case, citing privacy laws.
In a prepared statement, hospital spokeswoman Carolyn Moore said the hospital maintains an infection-control program that includes surveillance of inpatients. She said Eastern Niagara takes the additional step of screening patients at admission for MRSA, which individuals can carry into a facility. Eugene L. Urban, chief executive officer of Odd Fellows, in a statement, said the nursing home has not been found to be in violation of any infection- control standards.
Much of the focus on infections has centered around staphylococcus aureus, a bacterium commonly carried on the skin or in the nose of healthy people. About 30 percent of healthy individuals in the community have staph living in their nose but aren't infected.
Staph can cause an infection, usually minor skin ailments, and outbreaks have become more common in locker rooms and schools. But another strain of staph bacteria occurs most frequently in hospitals and nursing homes, where it can cause serious infections in the blood, lungs and surgery sites.
MRSA, or methicillin-resistant staphylococcus aureus, is the type of staph that is resistant to common antibiotics. Of the individuals living with staph in their noses, an estimated 1 percent have the MRSA strain.
The community-acquired strain of MRSA is a growing problem, including in Buffalo.
A study reported this year of Kaleida Health hospitals reflected what is happening across the country. The rate of suspected community-acquired MRSA in patients increased for adults from 56 percent in 2003 to 71 percent in 2006, and for children from 26 percent to 64 percent.
Most MRSA occurs in health care facilities, where the bacteria can enter the body through wounds, catheters and ventilators. Older and weakened patients are especially vulnerable.
"It's complicated for hospitals because you often can't differentiate hospital-acquired MRSA from the community variety," said Dr. Chiu Bin Hsiao, lead author and associate professor of infectious diseases at the University at Buffalo.
MRSA is just one of many antibiotic-resistant pathogens that pose a danger to patients and that can be spread by skin-to-skin contact or by touching contaminated items. Others include acinetobacter, pseudomonas aeruginosa and clostridium difficile.
Cases of clostridium difficile are now more common than MRSA in community hospitals, according to research reported in March at an international conference on health care infections. These bacteria normally live in the large intestine, but taking antibiotics for other infections can wipe out the "good" bacteria in the digestive tract that keep them from proliferating like weeds on a lawn.
Efforts under way to curb infections include financial penalties by Medicare and private insurers for preventable episodes in hospitals, screening of patients for MRSA and hospital-acquired infection reporting by more than half the states.
New York last year began releasing 12 different infection rates for hospitals. No one facility was found to have a high infection rate across the board, but officials say it's premature to draw conclusions.
"The public perception has been that a patient comes into a hospital and gets an infection. But the problem is much more complex, with different types of infections in different health care settings," said Rachel Stricof, director of the state's bureau of health care-associated infections.
One solution is to deny payment to hospitals for some infections, although critics contend it's impossible to eliminate all infections. They say the penalties don't account for patients who are extraordinarily ill, or for the way patients routinely move through multiple facilities for care.
Veterans Affairs hospitals began screening patients for MRSA in 2007. The mandated measure resulted in a decline nationally in transmission of MRSA and new infections, although a recent study at the VA Medical Center in Buffalo did not find a similar drop in new infections over the first two years of the program for reasons that remain unclear.
Screening may work against MRSA, but its high cost would impose a huge financial burden on private hospitals with far more patients, said Dr. John Sellick, lead author of the study and the medical center's epidemiologist.
"There are a lot of other infections to control, and hospitals don't get reimbursed more for these measures. You have to consider what is the best use of your human and laboratory resources," he said.
Sellick said hospitals should encourage a culture in which the entire staff buys into a system of infection control.
To Brennan-Taylor, who took her mother's death hard, what's needed at a minimum is a change in thinking about the scale of the problem.
"The deaths are isolated, so they don't get much attention," she said. "But it's akin to a jumbo jet crashing every other day."
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How the Overuse of Antibiotics is Making Treatment More DifficultOriginally from: http://www.nursinglink.monster.com/news/articles/12421-how-the-overuse-of-antibiotics-is-making-treatment-more-difficult
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