America’s Antibiotic Crisis

The following three articles in a three-part series examine the unrestrained use of antibiotics that sickens at least 2.25 million Americans each year and kills another 37,000 people:

The Rise of Superbugs

How Your Hospital Can Make You Sick

5 QUESTIONS to Ask Your Doctor Before Taking Antibiotics

The Rise of Superbugs

Dangerous infections that are resistant to antibiotics are spreading and growing stronger, with dire consequences. Medical experts say it’s a mess of our own making—and the clock is ticking on when and how we must solve it. The first in a three-part series.

The next time you’re offered a prescription for antibiotics and ask yourself, “What harm could it do?” think about Peggy Lillis.

Five years ago, the 56-year-old kindergarten teacher from Brooklyn, N.Y., was given the antibiotic clindamycin, which was supposed to prevent a dental infection. Instead, the drug wiped out much of the “good” bacteria in her gut that normally keeps “bad” bacteria in check. Without that protection, harmful bacteria in her belly ran rampant, triggering an intestinal infection so severe that doctors had to perform emergency surgery to remove her colon. Despite that desperate, last-ditch effort, “within 10 days of taking those pills, my mother was dead,” says Lillis’ son, Christian.

Or consider Zachary Doubek, a rambunctious 12-year-old from New Brunswick, N.J. After a baseball game, Zachary came home complaining of knee pain that worsened overnight and quickly escalated. His doctor initially prescribed an antibiotic that failed to bring the problem under control. Zachary had the bad luck of running into a strain of bacteria that, after repeated exposure to antibiotics, had evolved, developing defenses against the drugs.

Zachary’s infection raced through his body, forcing doctors to put him in a medically induced coma until they could rein it in with vancomycin, a powerful antibiotic that, luckily, still worked against the germ. Zachary survived, but a year and six surgeries later, he still walks with a limp from the ordeal. “We may never know how he got infected,” says his mother, Marnie Doubek, M.D., a family physician, “but we know that the antibiotic that should have first helped him didn’t work.”

 

Raising the Alarm

Peggy Lillis’ and Zachary Doubek’s stories are all too common. Though antibiotics have saved millions of lives since penicillin was first prescribed almost 75 years ago, it’s now clear that unrestrained use of the drugs also has unexpected and dangerous consequences, sickening at least 2.25 million Americans each year and killing 37,000.

That harm comes in two main ways. First, as in Lillis’ case, antibiotics can disrupt the body’s natural balance of good and bad bacteria, which research shows is surprisingly important to human health. Lillis was killed by one such bad bug, the bacteria C. difficile. At least 250,000 people per year now develop C. difficile infections linked to antibiotic use, and 14,000 die as a result.

Second, overuse of antibiotics breeds “superbugs”—bacteria that often can’t be controlled even with multiple drugs. (See “From Bug to Superbug,” below.) Doubek was a victim of MRSA (methicillin-resistant staphylococcus aureus), a bacteria once con ned to hospitals that has now spread into the community, including nail salons, locker rooms, and playgrounds—where Doubek may have picked up his infection. MRSA and other resistant bacteria infect at least 2 million people in the U.S. annually, killing at least 23,000.

As alarming as those numbers are, experts say things could get much worse, and fast. The Centers for Disease Control and Prevention has sounded the alarm about two threats: CRE (carbapenem-resistant enterobacteriaceae), which— when it gets into the bloodstream—kills almost 50 percent of hospital patients who are infected; and shigella, a highly contagious bacteria that overseas travelers often bring home and that is now resistant to several common antibiotics, raising fears of an outbreak in the U.S.

The World Health Organization and the European Union call the rise of resistant bacteria one of the world’s most serious health crises, putting us on the verge of a “post-antibiotic era.” In June, President Obama convened a forum on the crisis at the White House attended by 150 organizations, including Consumer Reports. And his 2016 proposed budget included $1.2 billion for combatting resistant infections.

A New Approach to Antibiotics

“We have to act now to reverse this problem,” says Thomas R. Frieden, M.D., director of the CDC. “If we lose the ability to treat infections, we lose the ability to safely do much of what we take for granted in modern medicine.”

Part of the solution may come from developing new antibiotics. But experts say it’s even more important that doctors, hospitals, and consumers develop a new attitude toward the drugs, learning when antibiotics should—and shouldn’t—be used.

That applies even to how the drugs are used on farms: About 80 percent of the antibiotics in the U.S. are fed to chickens, cows, and other food animals, mostly to speed their growth and to prevent disease.

Frieden and others say the problem, although complex, is fixable—if we act now. Here, what you need to know about antibiotic overuse and its consequences, and how to protect yourself and your family:

Miracle Drugs Gone Awry

“Antibiotics really are miracle drugs. Patients believe that. I believe that,” says Lauri Hicks, D.O., head of the CDC’s program Get Smart: Know When Antibiotics Work.

Ask anyone who has had a brush with bacterial meningitis. About 85 percent of people treated with antibiotics for that infection survive; without the drugs, almost all die. In fact, many of the advances of modern medicine—organ transplants, invasive surgery, cancer therapy, among others—depend on antibiotics. For example, without the drugs up to 40 percent of people undergoing total hip-replacement would develop an infection and almost one-third of those would die.

But antibiotics have become a victim of their own success. “The drugs seemed so effective that we started using them even in cases when they shouldn’t be,” Hicks says. Overall, in fact, the CDC estimates that up to half of all antibiotics used in this country are prescribed unnecessarily or used inappropriately.

The Many Forms of Misuse

Antibiotic misuse happens in many ways:

• Using the drugs to treat illnesses caused by viruses, not bacteria. Doctors know, of course, that antibiotics don’t work against viruses, like those that cause the common cold or the flu. But in some cases tests can’t help distinguish between the two. Or doctors may feel that they just don’t have the time to determine the cause, and figure “it’s better to be safe than sorry.” One recent study of 204 doctors suggested some physicians may be more likely to prescribe antibiotics for viral infections toward the end of their office hours—a sign they may be taking the easy route to handling patients’ complaints.

• Prescribing the drugs just to satisfy patient demand. Doctors may also just want to make their patients happy—and patients often want antibiotics. For example, in a recent Consumer Reports poll of 1,000 adults, one in five people who got an antibiotic had asked for the drug. “I often have patients who ask for antibiotics,” says Marnie Doubek, who sees many sick children in her practice. “So I understand the pressure to just say OK. But now, especially with Zachary’s experience, no way.”

• Rushing to drugs too quickly. Even when infections are caused by bacteria, doctors sometimes prescribe antibiotics when it might be wise to wait a few days to see whether mild symptoms clear up on their own. One example: ear infections in children older than 6 months. When mild, those infections often improve untreated. But as many parents know, a crying child can be a powerful motivator to seek a quick fix even if, in the long run, repeated use of antibiotics may be more likely to cause problems than solve them.

• Abusing broad-spectrum drugs. When antibiotics are called for, doctors often reach too quickly for “broad spectrum” ones that attack multiple bacteria types at once. That shotgun approach is not only more likely to breed resistance but also to wipe out protective bacteria. The drug that triggered Lillis’ C. diff infection, clindamycin, is one such drug.

Those drugs were developed with the thought that “killing as many bugs as you possibly can in every patient” was a good idea, says John Powers, M.D., former lead medical officer of Antimicrobial Drug Development and Resistance Initiatives at the Food and Drug Administration.

Doctors loved the broad-spectrum antibiotics and, spurred by aggressive marketing from drug companies, began using them for common problems such as ear and sinus infections. Given that widespread use, “it’s hardly a shock that we now have a problem with resistance and C. diff,” Powers says.

The Quest for New Drugs

Many of those broad-spectrum drugs were introduced 30 years ago, when antibiotic development was in its heyday. More than 50 antibiotics were introduced in the 1980s and 1990s. But that once-steady drug pipeline has slowed to a trickle, for several reasons.

One is that coming up with new classes of antibiotics that target superbugs is proving to be a tough scientific puzzle. Most of the new antibiotics introduced since 2000 have been minor tweaks to existing drugs, not major breakthroughs.

The other big reason? Money. “Developing antibiotics is not that pro table,” says Henry Chambers, M.D., an infectious disease specialist at the University of California San Francisco School of Medicine. Drug companies would rather focus on medications that many people take for a long time, he explains, because the market, and profit potential, is larger.

The government is trying to sweeten the economic incentive. In 2012, the FDA began to fast-track certain antibiotics and told drugmakers that patent protection on the drugs would last an additional five years. Since then, 49 new drugs have entered the pipeline’s fast lane and six have been approved.

The FDA has proposed further streamlining—allowing companies to test drugs using smaller, shorter, or fewer studies— for antibiotics that are meant to treat serious infections in patients with no other options. Legislation now with Congress would also lower the requirements needed to get new antibiotics on the market.

The Danger of ‘Fast Track’ Drugs

That approach means the FDA “is willing to accept less safety and efficacy data,” acknowledges Edward Cox, M.D., director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research. But he says that’s a trade-off that many doctors are willing to make. Still, some researchers and patient advocates worry about fast-tracking drugs. “We absolutely need new antibiotics,” says Lisa McGiffert, director of Consumer Reports’ Safe Patient Project. “But that doesn’t justify lowering the bar on the standards for drug approval. These can be dangerous drugs, so they should be thoroughly tested for safety and efficacy before we unleash them on the public.”

Perhaps the biggest concern is that even if effective new antibiotics make it to market, they may not provide much long-term help if health care professionals and patients continue to misuse the drugs. And, Chambers says, there may be pressure on doctors to use the drugs widely, despite the growing threat of antibiotic resistance.

Some pressure may come from drug companies, which have a history of marketing new drugs aggressively, and even illegally. Pfizer agreed to pay $1 billion in 2009 to settle allegations that the company illegally promoted four drugs, including the antibiotic linezolid (Zyvox), which was pushed to treat forms of MRSA for which it was not approved.

The Real Antibiotic Solution

With education and a little prodding, doctors have shown that they can do better. One study, in the Journal of the American Medical Association, found that doctors who attended a 1-hour session on guidelines for treating common upper-respiratory tract infections and then received feedback on their prescribing habits, cut their use of broad-spectrum antibiotics almost in half. Inappropriate prescriptions for sinus infections and pneumonia were cut by 50 to 75 percent.

 

Several medical organizations, such as the American Academy of Family Physicians and the American Academy of Pediatrics, have distributed guidelines on appropriate antibiotic use to their members. In some cases, that advice is incorporated into electronic medical records, so doctors are alerted if they prescribe a drug inappropriately.

Still, patients play a key role, too, by helping to make sure those drugs are used only when necessary, and by avoiding infections in the first place. Here are a few guidelines to follow:

• Don’t push for antibiotics. If your doctor says you don’t have a bacterial infection, don’t insist. Ask about other treatments that can help you feel better, such as a pain reliever, throat soother, antihistamine, or decongestant.

• Ask whether you can fight it off on your own. If bacteria are the cause but your symptoms are mild, ask about trying to fight o  the infection without drugs.

• Request targeted drugs. When possible, your doctor should order cultures to identify the bacteria that caused your infection and prescribe a drug that targets that bug.

• Use antibiotic creams sparingly. Even antibiotics applied to the skin can lead to resistant bacteria. So use over-the-counter ointments containing bacitracin and neomycin only if dirt remains after cleaning with soap and water.

• Avoid infections in the first place. That means staying up to date on vaccinations. And it means washing your hands thoroughly and regularly, especially before preparing or eating food, before and after treating a cut or wound, and after using the bathroom, sneezing, coughing, and handling garbage. Plain soap and water is best. Avoid antibacterial hand soaps and cleaners, which may promote resistance.

 

Kids are at risk too

Zachary Doubek and his mother, Marnie, in the park near his home in New Brunswick, N.J., where the 12-year-old boy may have been exposed to MRSA. That bacteria, which is resistant to several antibiotics, can lead to a range of illnesses, including skin infections and pneumonia—and almost killed Zachary. MRSA infections have now been traced to sports equipment and schools, gyms, locker rooms, and day-care centers.

From Bug to Superbug: How Bacteria Armor Up

“We all have bacteria living in and on our bodies,” says Lauri Hicks, D.O., of the Centers for Disease Control and Prevention. When we take an antibiotic, some bacteria survive—and evolve—so that the next time they encounter that drug, it might not work against them. “It’s a matter of survival,” Hicks says.

Every time we develop a new antibiotic, bacteria evolve to shrug it o . “The ability of bacteria to adapt allows them to become resistant very quickly,” says Jeffrey S. Gerber, M.D., an infectious disease expert at the Children’s Hospital of Philadelphia. “Bacteria have found a way to become resistant to every antibiotic man has made,” he adds.

The new, resistant bacteria may not make you sick right away but could lead to a future infection that is more difficult for doctors to treat.

And you can spread the bacteria to surfaces you touch or to people you shake hands with, kiss, or hug. So you can pass the bacteria on to friends, family members, co-workers, and others, spreading those bugs throughout your community even if you never get sick yourself.

As the bacteria circulate, they can become resistant to multiple antibiotics. Several of those “superbugs” have developed the ability to fend o  all or almost all of the drugs we have.

“Entire intensive care units have had to be shut down because of these super-bugs,” Gerber says. As a result, “people are dying of infections that we have zero antibiotics left to treat.”

6 Myths About Antibiotics 

Myth #1. They can cure colds and the flu. Antibiotics work against only bacterial infections, not viral ones such as colds, the flu, most sore throats, and many sinus and ear infections.

Myth #2. They have few side effects. Almost 1 in 5 emergency-room visits for drug side effects stems from antibiotics; in children, the drugs are the leading cause of such visits. Effects include diarrhea, yeast infections, and in rare cases, nerve damage, torn tendons, and allergic reactions that include rashes, swelling of the face or throat, and breathing problems. And the drugs can kill  o  good bacteria, increasing the risk of some infections.

Myth #3. A ‘full course’ lasts at least a week. Not always. A shorter course can work for some infections, such as certain urinary tract, ear, and sinus infections. So ask your doctor for the shortest course of antibiotics necessary to treat your infection.

Myth #4. It’s OK to take leftover medication. Nope. First, you may not need an antibiotic at all. And if you do, the leftovers may not be the right type or dose for your infection. Taking them could allow the growth of harmful bacteria. Return unused antibiotics to the pharmacy or mix them with coffee grounds or cat litter and toss in the trash.

Myth #5. All bacterial infections require drugs. Mild ones sometimes clear up on their own. So ask your doctor whether you could try waiting it out.

Myth #6. The more bacteria a drug kills, the better. Wrong. So-called broad-spectrum drugs, such as ceftriaxone, ciprofloxacin and levofloxacin, should be reserved for hard-to-treat infections.

Christian Lillis (left) and his  brother Liam outside their family home in Brooklyn, N.Y., with a picture of their mother Peggy. She died when an antibiotic prescribed after a routine root canal killed off “good” bacteria in her stomach, allowing a “bad” bacteria, C. difficile, to spread throughout her body. At least 250,000 people per year are sickened by C. diff infections linked to antibiotic use, and 14,000 die. The family responded to the tragedy by creating the Peggy Lillis Memorial Foundation (peggyfoundation.org).

When To Say No To A Prescription 

An April 2015 Consumer Reports survey of 1,000 adults found that patients are often prescribed antibiotics when the drugs aren’t necessary, such as for colds, the flu, many sinus infections, and before certain dental or medical procedures. Several major medical organizations, including the American Academy of Family Physicians and the American Academy of Pediatrics, have recently tried to correct the problem by identifying conditions for which antibiotics are often misused and explaining when the drugs  are, and aren’t, needed:

EAR INFECTIONS

Most ear infections improve on their own in two to three days even without drugs, especially in children 2 or older. 

When to consider antibiotics The drugs may be needed right away for babies 6 months or younger with ear pain, children from 6 months to 2 years old with moderate to severe ear pain, and children 2 or older with severe symptoms.

ECZEMA Antibiotics don’t help relieve skin from itching or redness. Instead, moisturize skin or ask your doctor to recommend a medicated cream or ointment.

When to consider antibiotics If there are signs of a bacterial infection, such as bumps or sores full of pus, honey-colored crusting, very red or warm skin, and fever.

EYE INFECTIONS

Doctors often prescribe antibiotic eyedrops after treating eye diseases, such as macular degeneration, with injections. But antibiotic drops are rarely necessary after such treatments and can irritate your eyes.

When to consider antibiotics If you have a bacterial eye infection, marked by redness, swelling, tearing, pus, and vision loss.

PINKEYE

Conjunctivitis usually stems from a virus or an allergy, not bacteria. Even when bacteria are responsible, pinkeye usually goes away by itself within 10 days.

When to consider antibiotics If you have bacterial pinkeye plus a weak immune system, or severe or persistent symptoms.

 

RESPIRATORY INFECTIONS

Colds, flu, and most coughs and cases of bronchitis are caused by viruses. Strep throat is bacterial, but only about one-third of sore throats in children are due to strep. If you suspect strep, get tested to find out for sure. 

When to consider antibiotics If a cough lasts longer than 14 days or a doctor diagnoses a bacterial illness such as strep.

SINUS INFECTIONS

Sinusitis is usually viral. And even when bacteria are the cause, the infections often clear up even if they are not treated in a week or so.

When to consider antibiotics If symptoms are severe, don’t improve after 10 days, or get better but then worsen.

SWIMMER’S EAR

Caused by water trapped in the ear canal, over-the-counter eardrops usually help as much as antibiotics, without the risk of those drugs and without causing resistance. 

When to consider antibiotics If you have a hole or tube in your eardrum, check with your doctor. In that case, certain antibiotic eardrops are a better choice. Oral antibiotics may be necessary if a bacterial infection spreads beyond the ear or you have other conditions, such as diabetes, that increase the risk of complications.

URINARY TRACT INFECTIONS IN OLDER PEOPLE

Doctors often prescribe antibiotics when a routine test finds bacteria in the urine. But if they don’t have symptoms, the drugs won’t help.

When to consider antibiotics Before certain surgeries or when you experience burning during urination and a strong urge to “go” often.

Avoid Germs at the Gym  

About 2 out of every 100 Americans carry potentially deadly MRSA bacteria on their bodies. Athletes, particularly those involved in contact sports, are even more likely to harbor the bacteria—in part because players share the bug when they come in contact with each other.

In addition, MRSA can live for days on exercise equipment, benches, and mats in gyms and locker rooms. So take these steps to protect yourself when working out in a gym:

• Wash your hands with soap and water before and after you work out. If that’s not available, use an alcohol-based hand sanitizer.

 

• Wipe down equipment with alcohol-based sprays or wipes.

• Place a barrier such as clothes or a clean towel between your skin and exercise equipment, benches, and mats.

• Keep cuts and scrapes clean and bandaged until healed.

• Shower immediately after you exercise.

• Never share personal items that touch bare skin, including towels, mats, bar soap, and razors.

How Your Hospital Can Make You Sick

Our centers for healing have turned into breeding grounds for dangerous—even deadly—infections. Consumer Reports’ new Ratings of more than 3,000 U.S. hospitals show which do a good job of avoiding the infections—and which don’t.

In the ongoing war of humans vs. disease-causing bacteria, the bugs are gaining the upper hand. Deadly and unrelenting, they’re becoming more and more difficult to kill. You might think of hospitals as sterile safety zones in that battle. But in truth, they are ground zero for the invasion.

Though infections are just one measure of a hospital’s safety record, they’re an important one. Every year an estimated 648,000 people in the U.S. develop infections during a hospital stay, and about 75,000 die, according to the Centers for Disease Control and Prevention (CDC). That’s more than twice the number of people who die each year in car crashes. And many of those illnesses and deaths can be traced back to the use of antibiotics, the very drugs that are supposed to fight the infections.

Terry Otey appears to be one casualty in that ongoing battle. Three years ago, a few weeks after an overnight stay for back surgery at Providence Regional Medical Center in Everett, Wash., he went to the emergency room vomiting, dizzy, and with excruciating back pain. Bacteria known as MRSA (methicillin-resistant staphylococcus aureus) had taken hold in his surgical incision and quickly spread to his heart. He died in the hospital about three months later, following a cascade of serious health problems. “He just wanted to ease his back pain enough to play golf,” says his sister, Deborah Bussell.

Kellie Pearson, 49, a farmer in northern California, says she encountered a different kind of bug after having heart surgery last April. Her doctors prescribed an antibiotic in the hopes that it would prevent a post-surgical infection. Instead the drug killed off healthy bacteria in her body, and another germ, C. diff (clostridium difficile), swooped in, causing diarrhea so severe that she had to stay in the hospital an additional five days until doctors could rein in the potentially deadly infection.

She recovered but soon realized that she wasn’t the only patient suffering. “When I was able to walk down the hall in the hospital,” she says, “I was horrified to see room after room with C. diff caution signs on their doors warning that the patients inside, like me, had been infected.”

In the Danger Zone

“Hospitals can be hot spots for infections and can sometimes amplify spread,” says Tom Frieden, M.D., director of the CDC. “Patients with serious infections are near sick and vulnerable patients—all cared for by the same health care workers sometimes using shared equipment.”

Making the situation even more dangerous is the widespread, inappropriate use of antibiotics that’s common in hospitals, which encourages the growth of “superbugs” that are immune to the drugs and kills off  patients’ protective bacteria.

It’s “the perfect storm” for infections to develop and spread, says Arjun Srinivasan, M.D., who oversees the CDC’s efforts to prevent hospital-acquired infections. “We’ve reached the point where patients are dying of infections in hospitals that we have no antibiotics to treat.”

But there’s hopeful news: Some hospitals are taking steps to reduce infections and end inappropriate antibiotic use. “But others have made little effort,” Srinivasan says.

What Our Ratings Show

Consumer Reports’ hospital Ratings shine a spotlight on the problem. For the first time ever, those Ratings include information on MRSA and C. diff infections, based on data that hospitals submit to the CDC. And the results are sobering.

Three out of 10 hospitals in our Ratings got one of our two lowest scores for keeping C. diff in check; four out of 10 got low marks for avoiding MRSA. Only 6 percent of hospitals scored well against both infections.

“Hospitals need to stop infecting their patients,” says Doris Peter, Ph.D., director of the Consumer Reports Health Ratings Center. “Until they do, patients need to be on high alert whenever they enter a hospital, even as visitors.”

But there’s plenty that hospitals can do to stop the spread of deadly, sometimes resistant infections, and there are steps you can take as well to keep you and your family safe.

Germ Warfare: Protect Yourself Against Superbugs

First step: Check our Ratings to see how hospitals in your community compare in preventing infections and other measures of hospital safety. (Subscribers to our website can go to ConsumerReports.org/hospitalratings.) But bad things can happen even in good hospitals. For example, Terry Otey developed his infection after a 2012 surgery in a hospital that now gets one of our higher ratings against MRSA. Our experts say there are several things you can do when you’re in the hospital and after you’re discharged to minimize your risk and spot symptoms of possible infection early:

Red Flags for Bad Bacteria

We are focusing on C. diff and MRSA for two important reasons.

First, the infections are common and deadly. More than 8,000 patients each year are killed by MRSA; almost 60,000 are sickened by the infections. The bacteria often find their way into patients’ bodies through the lines and tubes that doctors use to deliver medication and nutrition to patients, or via surgical incisions, as happened to Terry Otey.

C. diff is an even bigger concern. Kellie Pearson is one of the 290,000 Americans sickened by the bacteria in a hospital or other health care facility each year. She was lucky: At least 27,000 people in the U.S. die with those infections annually.

Second, poor MRSA or C. diff rates can be a red flag that a hospital isn’t following best practices in preventing infections and prescribing antibiotics. That could not only allow C. diff and MRSA to spread but also turn the hospital into a breeding ground for other resistant infections that are even more difficult to treat.

For example, as dangerous as MRSA is, an infection can be cured if it is treated promptly with vancomycin, long held out as an “antibiotic of last resort.” But, in part because that drug is now so often used in hospitals, another resistant strain of bacteria—vancomycin-resistant staphylococcus aureus, or VRSA—is emerging. “VRSA infections pose special challenges; they can be even more difficult to treat than MRSA,” Srinivasan says.

Hospitals That Rate Well

To earn our very top rating in preventing MRSA or C. diff, a hospital has to report zero infections—an admittedly high bar. Still, 322 hospitals across the country were able to achieve that level in our MRSA ratings, and 357 accomplished it for C. diff, showing that it is possible. (Experts say some hospitals might game the system. For details, see “How Hospitals Fudge the Numbers.”)

More hospitals were able to earn either of our two highest ratings—indicating that they reported either zero infections or did much better than predicted compared with similar hospitals: 623 hospitals received high marks for MRSA, and 917 did so for C. diff.

Hospitals really begin to distinguish themselves when they earn high ratings against both infections: 105 hospitals succeeded in that. Even

 

better, some hospitals excel against not only MRSA and C. diff but also other infections that the CDC tracks and that are in our Ratings. Those include surgical-site infections and infections linked to urinary catheters or central-line catheters, large tubes that provide medication and nutrition.

“Hospitals that do well against infections across the board have figured something out and deserve special mention,” Peter says. Only 9 hospitals in the country—those featured in the “Highest-Rated in Infection Prevention” chart—earned that high honor.

And Hospitals That Don’t

You won’t find any familiar, big-name hospitals on that top-performing list. In fact, several high-profile hospitals got lower ratings against MRSA, C. diff, or both, including the Cleveland Clinic in Cleveland, Johns Hopkins Hospital in Baltimore, Mount Sinai Hospital in New York City, and Ronald Reagan University of California Los Angeles Medical Center. Those are all large teaching hospitals in urban areas, which in our analysis did not do as well as non-teaching hospitals of similar sizes in similar settings. That could be because teaching hospitals may do a better job of reporting infections. Or, as a representative for Ronald Reagan UCLA Medical Center told us, they may see sicker patients or have more patients undergoing complex procedures. Although the CDC adjusts the data to account for some of those factors, teaching hospitals tend to perform worse. For example, only 6 percent of teaching hospitals received one of our two top scores against C. diff, compared with 14 percent of similar non-teaching hospitals.

“Yes, teaching hospitals face special challenges. But they are also supposed to be places where we identify best practices and put them to work,” says Lisa McGiffert, director of the Consumer Reports Safe Patient Project. “Obviously, that is not happening as well as it should.” Larger hospitals also tended to do worse in our Ratings. That could be because patients in smaller hospitals are less likely to be exposed to infections. But some larger hospitals managed to do a good job avoiding infections. Case in point: Harlem Hospital Center in New York City earned high ratings against MRSA and C. diff. Or consider North-west Texas Healthcare System in Amarillo, Texas. It made it onto our list of top hospitals in the prevention of all of the infections included in our Ratings.

What Safe Hospitals Do

Good hospitals focus on the basics:

USE ANTIBIOTICS WISELY. Almost half of hospital patients are prescribed at least one antibiotic, Srinivasan says, but “up to half the time the drug is inappropriate.” To combat antibiotic misuse, many good hospitals have “antibiotic stewardship” programs, often headed by a pharmacist trained in infectious disease, to make sure that patients get the right drug, at the right time, in the right dose.

Such programs often monitor the use of broad-spectrum antibiotics. Doctors at some hospitals use three times more of those all-purpose bug killers than others. Reducing broad-spectrum prescriptions by 30 percent would “cut hospital rates of C. diff by more than 25 percent, plus reduce antibiotic resistance,” says Clifford McDonald, M.D., a CDC epidemiologist.

KEEP IT CLEAN. C. diff and MRSA can live on surfaces for days and can be passed from person to person on hospital equipment or the hands of health care workers. To prevent that, hospitals must be kept scrupulously clean. “Infection control is all about the basics, starting with hand hygiene,” says Christine Candio, president and CEO of highly rated St. Luke’s Hospital in Chesterfield, Mo. She reminds patients, “it’s your right to ask” staff to wash up. In fact, fastidious hand washing slashes rates of C. diff, MRSA, and other infections. St. Luke’s also “prioritizes cleanliness,” in some cases exceeding infection-control guidelines—cleaning the rooms of C. diff patients twice daily, for example, and replacing curtains between patients.

 

I'm a fighter

Barbara Thom, 61, says it was plenty scary undergoing surgery for a benign brain tumor at Sacred Heart Hospital in Eau Claire, Wis., in 2010. But the worst was still to come.

Two different bacteria invaded her incision site and wreaked havoc despite treatment with multiple antibiotics. Ultimately, to control the infections, doctors had to replace part of her skull with surgical mesh and put her on high doses of antibiotics that, five years later, she still must take every day. “I’m a fighter, so I’m going to keep doing whatever it takes,” Thom says, though she worries that the drugs will eventually stop working. “It’s the unknown that scares me.”

Photo by Andy Richter

'Be your own advocate'

Kellie Pearson recovered from a life-threatening case of C. diff caused by antibiotics she got in the hospital. But shortly after, she says, her doctor wanted to prescribe a broad-spectrum antibiotic to prevent infection in her incision. “I was shocked because that could trigger the C. diff all over again,” she says. Her takeaway: “You have to be your own advocate.”

What More Needs to Be Done

Steps such as those, plus federal mandates for some public reporting of infections data, have already led to reduced rates of certain infections. Still, McGiffert says hospitals need to do more:

• Consistently follow the established protocols for managing superbug infections, such as using protections including gowns, masks, and gloves by all staff.

• Be held financially accountable. Already, hospitals in the bottom 25 percent of the government’s data at preventing certain complications now have Medicare payments docked 1 percent. But they should also have to cover all costs of treating infections patients pick up during their stay. 

• Have an antibiotic stewardship program. That should include mandatory reporting of antibiotic use to the CDC.

• Accurately report how many infections patients get in the hospital. And the government should validate those reports.

• Be transparent about infection rates. For instance, Cleveland Clinic acknowledges its below-average performance in C. diff prevention on its website. “That’s refreshingly candid,” Peter says.

• Promptly report outbreaks to patients, as well as to state and federal health authorities. Those agencies should inform the public so that patients can know the risks before they check into the hospital.

Fighting Bad Bugs with Good Ones

Antibiotics kill off  not only bad bacteria that make you sick but also good bacteria that help keep you healthy. So replenishing the good bugs in your digestive tract seems to make sense. That’s the idea behind two growing trends: probiotics and fecal transplants.

Probiotics

There’s some evidence that probiotics might shorten a bout of diarrhea caused by antibiotics. And an analysis of 23 clinical trials found that taking probiotics with antibiotics can greatly cut the risk of diarrhea caused by C. diff.

Probiotics may be worth a try if you’re on antibiotics for more than a few days, taking two antibiotics at once, or you’re switched from one drug to another. People older than 65 and those who take an acid-blocking drug such as Nexium or Prilosec are at higher risk for C. diff; check with your doctor to see whether probiotics will help you.

Research suggests that the most effective probiotics are combinations of L. acidophilus, L. casei, L. rhamnosus, and S. boulardii. To reduce the risk of diarrhea caused by C. diff, the most effective dose is thought to be more than 10 billion colony forming units, or CFU, daily.

You don’t have to take a pill to get those good bacteria. Yogurts we tested several years ago contained an average of 90 billion to 500 billion CFU per serving. Probiotic supplements contained less, from just fewer than 1 billion to 20 billion CFU per capsule.

Probiotics should be avoided by people with compromised immune systems or serious medical conditions because of a rare risk of bloodstream infections.

Fecal Transplants

For C. diff infections that keep coming back, a “fecal microbiota transplant” is nothing short of a miracle. In the procedure, a doctor places stool from a healthy donor into an infected person’s colon, usually using colonoscopy. The idea is to repopulate the colon with good bacteria to fight off C. diff. Research shows that it works about 90 percent of the time. In 2013 the Food and Drug Administration decided to allow doctors to perform the procedure in C. diff patients with diarrhea and other symptoms even after being treated with antibiotics.

Some recent reports suggesting that fecal transplants may have other benefits—including weight loss. As a result, a cottage industry of “poo practitioners” has emerged. Some people are even going the DIY route.

“That’s a terrible idea,” says Christina Surawicz, M.D., a gastroenterologist and professor at the University of Washington School of Medicine. For example, there have been reports of people developing autoimmune disorders after the procedure and even suddenly gaining weight.

Instead, if you have C. diff, look for an infectious disease doctor or gastroenterologist with experience in the procedure. The stool can come from a friend or family member, or doctors can buy frozen specimens from screened donors. Check with your insurance company to see whether it will cover fecal transplants to treat C. diff.

The Hard Work of Fighting Infections

Presence Saints Mary and Elizabeth Medical Center in Chicago shows that even large urban hospitals can do a good job preventing infections—though there are advances and retreats in the ongoing battle. When our September 2015 issue went to press, it was among an elite group of hospitals that earned top Ratings not only against MRSA and C. diff but also against infections following surgery and those associated with urinary-tract and central-line catheters. But based on the most recent government data, released after we published, the hospital went down a notch in two areas—although it still performs well overall in preventing infections. It manages to do this in spite of its high volume of patients, many of whom are minorities—two factors linked to increased infection rates.

“Preventing infections is not something we view as a separate task,” says Christine Balintona, R.N., a critical-care nurse specializing in infection control. “From the leadership, who have provided strong support, to doctors and nursing staff to people who bring meals and clean the rooms—everyone knows how important it is.”

She credits ongoing education keeping staff up to date on new protocols, as well as diligence about basics such as hygiene. “We make rounds every day to observe and educate patients,” Balintona says. And “departments have a friendly competition to get the best report” from “secret shoppers” on their hand washing.

A key element of Presence’s success: an antibiotic stewardship program. “We’re a multidisciplinary team,” says Ben Colton, Pharm.D., a pharmacist specializing in infectious disease. “Every day, pharmacists, doctors, biologists in the lab, and infection-control people are all working together to arrive at the best treatment for the patient.”

Highest- and Lowest-Rated in Infection Prevention

Guide to the Ratings. Ratings reflect how hospitals performed in a snapshot in time, based on data hospitals reported to the CDC. The data are released periodically throughout the year. (The Ratings that appear in the September 2015 print issue of Consumer Reports magazine were the most currently available at publication, based on data reported to the CDC between July 2013 and June 2014.)

Infections Composite indicates how a hospital did against MRSA and C. diff infections plus surgical-site infections and infections associated with urinary-tract and central-line catheters. The CDC adjusts to account for factors such as the health of a hospital’s patients, its size, and whether it’s a teaching hospital. For complete and the most current Ratings, online subscribers can go to ConsumerReports.org/hospitalratings.

How Hospitals Fudge the Numbers

Hospitals must report certain infections, including C. diff and MRSA, to the CDC if they want to avoid payment penalties from the Centers for Medicare & Medicaid Services. Consumer Reports uses that data, the best available, for our hospital Ratings. But there is no comprehensive system for auditing the data to guarantee that those reports are accurate. And research suggests that hospitals fail to report a shockingly high percentage of infections.

For example, a Harvard study that compared medical records with patient interviews found that patients reported about twice as many infections and other complications as the hospitals had documented. And a report from the Department of Health and Human Services’ Office of Inspector General found that hospitals reported less than 25 percent of infections in Medicare patients.

Underreporting may stem in part from sloppy record keeping. “Some hospitals, especially smaller ones, haven’t put systems in place to collect and report infection data in a standardized way,” says Eric Schneider, M.D., an author of the Harvard study. But in other cases, it may be more deliberate. “For example, a hospital may claim that a

patient checked in with the bug, which doesn’t count against the hospital, when in fact she developed it as an inpatient.”

“There’s reason to be skeptical about the accuracy of infection data,” says Lisa McGiffert, director of the Consumer Reports Safe Patient Project. “That’s why we want reporting by patients and their families to be included.”

What You Can Do to Help

To get our top rating against MRSA or C. diff, a hospital has to report zero infections. “It’s possible, and it’s a standard we want to hold all hospitals to,” McGi ert says. “But we know that some hospitals may not tell the whole truth.”

To help us check, go to ConsumerReports.org/zeroinfections to see a list of all of the hospitals in our Ratings that claimed zero MRSA or C. diff infections between October 2013 and September 2014 (the most recent data available at press time). If you were treated in one of those hospitals in that time frame—and you developed an infection— we want to hear your story.

How To Say No to Antibiotics

On any given day in the hospital, half of patients are given an antibiotic and 25 percent get two or more, according to the CDC. But up to half of the time, doctors don’t use the drugs right. “It can feel awkward to talk to your doctor about antibiotics,” says Conan MacDougall, Pharm.D., a team leader for antibiotic stewardship at the University of California at San Francisco. But asking a few simple questions can “encourage physicians to be more thoughtful about prescribing,” MacDougall says.

1. What Is This Drug For?

If your doctor suspects a bacterial infection, ask whether you can be tested for it; results can confirm the infection and determine the type of bug, which can dictate the type of antibiotic that works best.

2. What Type Is It?

If a narrower-spectrum drug such as penicillin will work against your infection, that’s usually a better choice than a broad-spectrum drug.

3. How Long Should I Take It?

Ask your doctor to prescribe the drug for the shortest time possible. (Be sure to take it for that duration.) Ask for the type and dose to be re-evaluated when test results are in. A common error, MacDougall says, is not switching from a broad-spectrum drug to a targeted one once the bug is identified.

4. What About Side Effects?

Most antibiotics are well tolerated; but in addition to C. diff, antibiotics can trigger serious allergic reactions, including rashes, swelling of the face and throat, and breathing problems. Some antibiotics have been linked to torn tendons and permanent nerve damage.

5 QUESTIONS to Ask Your Doctor Before Taking Antibiotics

Do I really need antibiotics?

Antibiotics fight bacterial infections, like strep throat, whooping cough and symptomatic bladder infections. But they  don’t fight viruses – like common colds, flu, or most sore throats and sinus  infections. Ask if you have a bacterial infection. 

What are the risks?

Antibiotics can cause diarrhea, vomiting, and more. They can also lead to “antibiotic resistance”– if you use antibiotics when you don’t need them, they may not work when you do need them. 

Are there simpler, safer options?

Sometimes all you need is rest and  plenty of liquid. You can also ask about antibiotic ointments and drops for  conditions like pink eye or swimmer’s ear.

How much do they cost?

Antibiotics are usually not expensive. But if you take them when you don’t need them, they may not work for you in the future – and that may cost you a lot of time and money. 

How do I safely take antibiotics?

If your doctor prescribes antibiotics, take them exactly as directed, even if you feel better. 

 

Use these 5 questions to talk to your doctor about when you need antibiotics–and when you don’t.

Antibiotics can help prevent or treat some infections. But if you use them for the wrong reason, they may cause unnecessary harm.

Talk to your doctor to make sure you only use antibiotics for the right reasons – and at the right time.

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