Although healthcare professionals and patients have learned to take precautions with gloves, masks, antiseptics, and other
obvious measures, infection prevention is still a lost cause for most ESRD patients. That's where the threat of antimicrobial
resistance comes in, especially the threat of methicillin-resistant staph aureus (MRSA), which has the CDC, FDA, WHO, and
just about every other public health agency in world in a justifiable state of emergency.
Mark L. Smith Like the man at the top, Smith is a CPA by training and spent eight years at Price Waterhouse in Sydney, Australia
and San Jose, California. Before Nabi, Smith worked for various healthcare companies, including Genzyme Genetics, a subsidiary
of the Genzyme Coproration. Words of wisdom: "It's good to make a better decision slowly than a bad decision very quickly.
But unless you act, you have not done something strategic. You have only thought about being strategic."
A resistant infection can keep otherwise healthy or recovering people in the hospital for days or even weeks after they are
scheduled for discharge. The costs associated with that extended stay were the subject of a presentation at the annual meeting
of the International Society for Pharmacoeconomics and Outcomes Research. Larry Liu, MD, PhD, director of US outcomes research
for Pfizer and lead investigator of a study examining the economic burden of MRSA on the healthcare system, concluded that
patients with MRSA stay an extra 10 days in the hospital, including time spent in the ICU, costing hospitals between $3.2
and $4.2 billion every year. And although that study was ostensibly done to support the use of Pfizer's antibiotic Zyvox (linezolid),
it illustrates how serious—and costly—the resistance problem has become.
"Hospital infections are caused by a number of bacteria, but the most common bug in the skin is Staph aureus, which is the meanest one of them," Husserl says. "It sometimes accounts for up to 50 percent of the bacteria that we see in
cultures. And it varies from area to area in the country and different programs. If patients are in nursing homes, there is
a much higher incidence. It is becoming more and more of a problem."
H. LeRoux Jooste He spent 20 years at companies such as Cephalon, Aton, Eli Lilly, and Wyeth, where he led the marketing
team that launched Enbrel (etanercept) with Immunex. At Lilly, he directed the launch of Prozac (fluoxetine) in South Africa–the
first country in the world to launch the drug. Words of wisdom: "What's our vision? It's that ultimately, there is recognition
that prevention is better than cure and that we will get there over time. If we try to achieve that tomorrow, we'll fail.
We need to make some sacrifices and do what's realistic in the short-term."
Husserl explains that ESRD patients are especially susceptible to staph infections because of the way the dialysis machines
are connected to their bodies. Hemodialysis patient have three options for access:
- an external catheter, which has the highest risk of infection and is used short-term
- an internal access which can either be made of a synthetic material such as Gore-Tex, or
- a surgical procedure called an arteriovenous (AV) fistula, in which an artery is connected to a vein.
What all these options have in common is that they require needle sticks—an average of six times a week. Even patients on
peritoneal dialysis, in which a catheter directs fluid into the abdomen, have a high infection rate.
"It is probably the second most common cause of death of our patients on dialysis," says Husserl. "The most common cause of
death is some kind of a cardiovascular event, but of the cardiovascular deaths, a large number are also due to infection.
About 30 percent have to do with gangrene of an extremity."