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Defense Department Responds to ‘Superbug’ Threat

By Cheryl Pellerin
American Forces Press Service

WASHINGTON, Sept. 30, 2010 – 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.

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

(Click photo for screen-resolution image);high-resolution image available.

"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."

Contact Author

Biographies:
Dr. Jack Smith

Related Sites:
Centers for Disease Control MRSA webpage
World Health Organization MDR- and XDR-TB webpage



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