Rules may be changed to track risky cases

Thursday, June 24, 1999

A Missouri report that fell through the cracks reflects demand for more oversight.

By Ron Sylvester

A highly transmissible, potentially incurable staph infection turned up two years ago in southeast Missouri.
Or not.

No one knows for sure, because the state does not require labs to report antibiotic resistance.

A year passed before the Missouri Department of Health learned, informally, about the infection called staph aureus that tested resistant to vancomycin – usually a hospital’s last line of antibiotic defense.

“That’s something you don’t want to find out a year later,” said Caryl Collier, communicable disease program administrator for the state.

This month, Missouri is considering changing its public health code to require reporting of vancomycin-resistant staph aureus.

The force of law, as much as a change in treatment habits, may be what it takes to untangle the web of diseases becoming immune to medication, experts say.

“It’s important for local and state lawmakers to realize how critical they are to getting this problem under control,” said David Fidler, a professor at the University of Indiana School of Law. “Under our system, they’ve got the real health powers, not the federal government.”

Fidler has advised agencies from the U.S. Centers for Disease Control to the World Health Organization on the need to toughen infectious disease laws to fight these “superbugs.”

Although the CDC can make recommendations, enforcement has to come at the local level – and at local expense. Springfield, for example, was one of the first cities in the state to require reporting of lead testing on children.

“It’s got to be people in Missouri that say, `Yeah, we’re going to be part of the solution on this, so we’re going to start requiring the reporting of resistant microbes as recommended by the CDC,’” Fidler said.

Yet even the proposed changes in Missouri with regard to staph don’t increase surveillance in other areas of antibiotic resistance.

Most states don’t require clinics and hospitals to report the most common infections, such as penicillin-resistant strep pneumoniae, according to a General Accounting Office report to the U.S. Senate this year.

Last week, state health officials were working on a plan to improve their surveillance of drug-resistant microbes through the Advisory Committee on Infections Control.

“One of the things we’re thinking about is creating a statewide network of laboratories to zero in on specific information,” Collier said.

A big hurdle, Collier said, is that labs across the state use varying methods for keeping records on antibiotic resistance.

The only way the state found out about the 1997 staph infection was through a voluntary survey in 1998. Even then, fewer than half the laboratories – 47 of 114 – bothered to return the survey.

“The state is obviously trying to correct a weakness in the system,” said Harold Bengsch, Springfield-Greene County health director and a member of the Missouri Board of Health.

State health officials doubt the potentially deadly staph infection existed, because they haven’t seen evidence it has spread. Other suspected cases have turned out to be false alarms after further testing at the state lab.

“And that’s the good news,” said Marge Borst, a nurse epidemiologist for the state’s office of communicable disease control. “The bad news is we just don’t know.”

Earlier this month, Borst sent a letter to hospital infection control officers and public health officials urging cooperation in reporting such staph infections.

Said Borst: “The CDC is concerned that we may be missing this within our communities.”