Last fall, when a nurse hung a bag of the antibiotic vancomycin on my IV pole, I had no idea that it had once been known as the antibiotic of "last resort." When you go in for scheduled surgery, as I did, your doctors will warn you that infections are one of the risks. What they didn't say was exactly how common they are and how often they become life-threatening. Before it was all over I became just one of 2 million Americans who get some kind of infection in a health-care setting each year. Seventy percent of those bugs are resistant to at least one kind of antibiotic.
In recent days the media has focused on MRSA (Methicillin-resistant Staphylococcus aureus), one of the more dangerous infections, which is blamed for the death of a 17-year-old high-school football player, among others. But MRSA is only a small part of the problem. There were 18,000 reported MRSA deaths in 2005—just a fraction of the nearly 100,000 deaths from all hospital-acquired infections.
My first bout with one of these superbugs came in July 2006, when, a few days after surgery to repair damaged nose cartilage, I woke to find the entire right side of my face swollen and my right eye completely closed. My doctors told me to get back to the hospital immediately. I was worried, of course, and I looked pretty scary, but I was a healthy 43-year-old—surely, I thought, there were plenty of powerful antibiotics that would kill the bacteria and set me right in a matter of days. Over the next two months I'd find out exactly how wrong I was.
That infection eventually put me back in the hospital two more times, for a total of 14 expensive and debilitating days. My doctors kept me in a little longer each time, hoping to give the IV antibiotics more time to kick in. It took a final eight-day stay in September to finally quell the infection. Most of the time I was in pain, but not really scared. However, at one point during that last long hospitalization, my blood pressure dropped to 78 over 50, and it finally dawned on me that the doctors might not be able to kill the bacteria that were colonizing my body. The drop in pressure was terrifying. It was a little like being in a dream where you think you're running, but you're not moving at all. Just reaching over to press the nurse call button was a huge effort, and there was a distinct feeling that my body was losing a battle.
During that period my doctors tried various combinations of the most powerful antibiotics as they struggled to find something that would stop the infection from spreading either into the new cartilage they'd just grafted into my nose or, worse yet, into my bloodstream, where it could make my whole system lethally septic. (Luckily, that never happened.) They brought in a rumpled Peter Falk-like infectious disease specialist who patrolled the halls of the hospital like a medical detective, ordering up cultures for the many patients like me fighting an onslaught of microbes impervious to pharmaceuticals.
The pattern of infection and treatment became familiar. They'd hospitalize me and start an IV, and after a day or so I'd feel fine. They'd release me with the pill form of an antibiotic, and then within a week or two the infection would out-evolve the drugs, which usually don't work as well when they're not administered intravenously. After a while I could tell when those bacterial armies were building strength even before the swelling and redness made it obvious. It was like the beginning of a horrible flu, a draggy, muddy feeling that clouds the mind.
I'd call my doc, he'd send me to the emergency room to be admitted, and off we'd go for another round of IV antibiotics. What was particularly frightening was how fast the progression was from that flu feeling to full-blown pain. In the few hours it took to get to the ER and be admitted, the swelling and pressure would increase so much that the nurses were administering morphine before I even got transferred to my hospital room.
As awful and frightening as my experience was, I'm one of the lucky ones. Those with more serious infections often have to have large swaths of tissue removed. In the most devastating cases these superbugs can start knocking out organs before the victim even realizes what's happening.
Whatever level of havoc these infections are causing individually, the toll they're taking nationally is staggering. The Centers for Disease Control report that in the last 15 years the number of people who have died from hospital infections has jumped almost tenfold—from about 13,300 in 1992 to nearly 100,000 in 2005. That's more deaths than from AIDS, breast cancer and auto accidents combined.
For several years now, the Committee to Reduce Infection Deaths (RID) has been sounding the alarm on this issue. In one recent report RID noted that more than 70 percent of blood pressure cuffs were carrying bacteria. The committee is pushing for testing of incoming patients for MRSA (in the same way the CDC now recommends that hospitals test for AIDS) and for beefed-up sanitary procedures for doctors and medical staff. The organization says several European hospitals have already implemented some of these measures, with success.
Preventive measures are key, because treatment after the fact may not work. Infectious disease specialists say we simply can't keep dousing ourselves with antibiotics. And the CDC reports that repeated and improper uses of antibiotics are one of the primary contributors to the increase in drug-resistant bacteria.
Even vancomycin, whose name is derived from vanquish, is buckling under the strain of these mutating microbes. There are increasing reports of vancomycin-resistant Staphylococcus aureus (VRSA). And some of vancomycin's much-heralded successors are already losing out. I was sent home once with a startlingly expensive and powerful drug called Zyvox, which has the distinct advantage of working as well in pill form as many antibiotics do in IV form. But even that didn't do the trick, and within a week I was back in the care of the compassionate nurses whom by now I had come to know by name.
Putting aside the tragedy of the tens of thousands of hospital-infection-related deaths, there are significant personal costs for those who survive an infection. Not only is there lost work time, family disruption and the angst of battling an enemy that is unpredictable and stealthy, but the financial price can be steep—particularly for those without comprehensive insurance. One course of Zyvox can cost nearly $2,000. RID calculates the national price tag for hospital-acquired infections at about $30.5 billion per year. Patients with the most stubborn or life-threatening bugs can end up in the hospital for 20, 40 or even 80 days at a time.
And it's not just a long stay on an IV drip. In my case, as in many others, doctors had to operate again to see how much damage was being done by the infection at the site of the original surgery and scrape out infected tissue. And every time they open you up, you're once again vulnerable to more problems—and rising hospital bills. I can't even begin to imagine what my 14 inpatient days cost. Nor do I want to consider the consequences for my family had I not had excellent health insurance.
All told, I missed at least six weeks of work. Worse yet, I wasn't there or was barely attentive for my daughters' first few weeks of school. I remember dressing my youngest child for the first day of kindergarten, sitting woozily through the "parent welcome" breakfast and then heading straight to bed until it was time to pick her up.
And though I'm healthy now, it's hard to shake the idea that the infection isn't really gone for good. This summer, almost a year to the date after the first hospitalization, I got that tell-tale fluey feeling again. I headed straight for the doctor's at the first inkling, and this time they knocked this nascent recurrence out with a whopping dose of antibiotics in pill form. Still, I'm left wondering if there might be some rogue microbes hiding somewhere in my body, just waiting for a weak moment to regroup and attack. And what medication options will I have the next time? It's a frightening question all too many of us will be faced with.