Many civilian doctors say that the risk from returning troops isn’t the main concern at this point, because acinetobacter is already rampant in U.S. hospitals. According to Dr. Brad Spellberg, associate professor of medicine at UCLA, who worked with the Infectious Disease Society to campaign for new drugs that treat multidrug resistant organisms, most medical centers are, “already saturated with this stuff.” He added that, most of his colleagues in academic medical centers, “have experienced this organism with fairly alarming frequency … any place you find sophisticated medical technology, you’re going to find this organism.”
As large and spread out as the military healthcare system may be, it has the advantage of central oversight and strict enforcement once policies are set. In contrast, most civilian hospitals do not share information, compliance standards or strategies for combating acinetobacter. Added to the fact that acinetobacter has no official tracking code from the CDC, it can be difficult for civilian facilities to identify and safeguard against the superbug.
In smaller, city hospitals like Nashville General, outbreaks of acinetobacter can cripple the ICU. Dr. L. Leon Dent is director of surgical care at Maherry Medical College and has authored studies on the outbreaks and prevention at the hospital. He agrees that antibiotic resistance and the ability to change itself are some of the biggest problems with treating acinetobacter. For smaller hospitals with limited funds and staff, it’s also difficult to discover the bacteria before they spread through the ICU and even harder to eradicate once there.
“I’m very afraid of this organism,” he said. “It has the potential to cause a lot of havoc in our hospitals. We’re doing a better job at hand hygiene and other things. But, we’re by no means close to solving the problem. We have to keep working on it. It’s a very sobering thing.”
Controlling acinetobacter infections
As hard as it is to kill as acinobacter, most doctors agree that the easiest way to prevent infections is stricter hygiene compliance and limiting antibiotic exposure, both in military and civilian hospitals. At the University of Maryland Medical Center, several studies are in progress on what level of hygiene measures, like increased hand cleaning and gown changing, can reduce infection. While that may seem like an easy fix, it requires a major investment for any hospital. Ensuring that hospital staff comply with infection control tactics and thoroughly clean equipment and surfaces to eradicate the bacteria requires time and money that many hospitals don’t have.
“We need new antibiotics, we also need better infection control — infection control interventions can be expensive,” said Dr. Anthony Harris, who has done several NIH funded research studies on acinetobacter at the University of Maryland Medical Center. “When nurses and doctors go in and out of a patient’s room 100 times a day, we don’t know how high their hand hygiene compliance has to be to limit the spread. Obviously, if it has be 100 percent, it may not be feasible.”
Although overuse of antibiotics helped create the superbug version of acinetobacter, finding new antibiotics is one important key to controlling it, doctors believe. The problem is their options are very limited; they need new varieties to keep the bacteria guessing. The only antibiotics that usually work against multidrug resistant acinetobacter are colistin and sometimes refampin or tigecycline, all of which are highly toxic. Colistin, the most commonly used agent for acinetobacter, can cause severe kidney and neurological damage and is considered an antibiotic of last resort.
A bill was introduced to Congress in July to provide incentive funding for the development of new antibiotics to treat these drug-resistant bacteria, including acinetobacter. The bill has won the support of the Infectious Disease Society, which has been lobbying for the funds with its “Bad Bugs, No Drugs,” campaign, and many other companies. But it’s got a long way to go in Congress and any new drug research must go through a 10 to 20 year approval process.
“There is no solution. There are many ways to address the problem,” said Spellberg. “It isn’t a choice of antibiotics or infection control prevention or immunotherapy or environmental decontamination. It’s all of the above.”