New findings are giving credence to the idea that superbugs, which resist the most powerful antibiotics, thrive just where the frailest people dwell: nursing homes.
A report published last month in the Journal of Clinical Microbiology found that more than a quarter of residents in 26 Orange County, California, nursing homes carried a bacterium known as MRSA, a rate that surprised researchers. Another study in April found that retirement-home residents in one area of Japan had three times more of another type of resistant bug than healthy locals.
The latest research adds to a growing body of evidence pointing to elderly residences as one of the weak links in the world’s escalating battle against the overuse of antibiotics and the rise of superbugs. The nature of those homes, with their mix of patients moving in and out of hospitals and living for extended periods in close proximity makes them a difficult environment to track and destroy germs.
“Antibiotic use is not as well-controlled as in the major teaching hospitals, and the cleaning of the environment wouldn’t be as stringent,” said Rhonda Stuart, head of infection control at Monash Health, the largest public health agency in Australia’s Victoria state. Those conditions “create an ideal environment for organisms like this to spread.”
As the global population of people 60 or older more than doubles in the next decade, those who move into elder care facilities are left vulnerable at a time when there are more cases of untreatable infection and less funding for antibiotics research. That translates to fewer new weapons to fight superbugs, experts say.
Antibiotics that are the last line of defense against life-threatening germs spread commonly in hospitals are starting to lose power in Europe, the European Centre for Disease Prevention and Control said last month. The U.S. Centers for Disease Control and Prevention estimates that more than 2 million people are sickened every year with resistant bugs, with at least 23,000 people dying as a result.
Drug resistance has brought the planet to the brink of what World Health Organization Director-General Margaret Chan in September described as “a post-antibiotic era, where common infections will once again kill.”
To be sure, efforts to come up with effective new drugs haven’t entirely disappeared. Last month, Roche Holding AG (ROG), the Basel, Switzerland-based drugmaker, agreed to pay as much as 500 million Swiss francs ($558 million) for the rights to an experimental antibiotic to target a bacterium that causes 1 in 10 hospital-acquired infections in the U.S.
In the meantime, scientists are beginning to recognize the role nursing homes can play in the struggle to control the spread of these deadly pathogens. The ECDC, which is funding a project on surveillance and control of infections in health-care facilities, including for antimicrobial resistance, published an article online in August that lays out indicators for control in long-term care facilities in more than 30 countries.
Many nursing homes are taking heed. At the 33 senior living communities run by Emeritus Corp. (ERC:US) across North America, for example, guidelines regulate everything from how employees clean bedside commodes to handling all linen “as if it were highly infectious.” Each home has its own infection-control committee, which meets monthly.
Governments are also taking measures. To discourage nursing homes from turning away people with hard-to-treat germs, Hong Kong’s social welfare department offers HK$5750 ($741) a month for nursing homes to buy alcohol-based hand rub and other protective equipment for the duration of an infected patient’s stay, according to an e-mail from the department. The homes also get a one-time HK$900 payment for equipment used exclusively by that person.
“The payment is a smart move: they’re positive measures that will lead to less stigmatization and create an economic incentive for nursing homes,” University of Hong Kong microbiologist K.Y. Yuen, who advises the local government on infectious outbreaks, said in an interview at his laboratory.
While such steps are helpful, they may ultimately fall short since they don’t attack the root problem.
“We’re really on the edge of having a big issue unless we start taking control of our antibiotic use,” said Monash’s Stuart.
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