California public health department opposes superbug tracking bill

A bill in the California legislature is designed to improve the state's tracking of antibiotic-resistant infections, but the state's public health agency opposes the measure, arguing that it would be ineffective.

California currently requires hospitals to report three types of antibiotic-resistant infections. SB 43 aims to set up a process for hospitals to track information about even more infections, and to send the data to the state in a special report called an antibiogram.

The California Department of Public Health opposes SB 43, because antibiograms can't be used to determine "numbers of infections or frequency of infections."

The Los Angeles County Department of Public Health is already collecting antibiograms from area hospitals and skilled nursing facilities, which are required to track 19 antibiotic-resistant organisms.

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Antibiograms are "an annual summary of susceptibility rates for selected bacterial pathogens," L.A. County Interim Health Officer Dr. Jeffrey Gunzenhauser wrote in his Jan. 2017 order requiring hospitals and nursing homes that generate these reports to furnish them to the county each year.

The antibiograms' data on local antimicrobial resistance "is combined with clinical expertise to guide optimal antimicrobial treatment for patients with CRE [Carbapenem-resistant Enterobacteriaceae] or other serious infections," he said.

The Infectious Disease Association of California endorses this tracking method; it says aggregating antibiogram data "will provide valuable information about antibiotic resistance patterns."

In a letter to SB 43 author Sen. Jerry Hill (D-San Mateo) informing him of its opposition, the California Department of Public Health argued that antibiograms don't provide an accurate picture of the scope of antibiotic-resistant infections.

Antibiograms "document the presence of specified bacteria, not specific infections," Public Health's deputy director for legislative affairs Monica Wagoner wrote in the letter. As an analysis "of bacteria isolated from patients with infections ... the antibiogram results are not linked in any way to individual patient data and cannot, therefore, be used to determine numbers of infections or frequency of infections with a particular antimicrobial resistance pattern as required by SB 43," she said.

"We rarely see a ... definitive opinion from a department in the state" about a bill, said Hill. "This is quite unusual and unexpected." He said he’s talking to Public Health about how to overcome its opposition.

The bill won't likely come up again before January, the beginning of the second year of the current two-year legislative session.

"We’re not going to give up," said Hill. "It’s too important and too much of an issue that has long-term consequences if we don’t continue the fight."

The Centers for Disease Control and Prevention estimates that antibiotic-resistant infections kill 23,000 Americans each year, and sicken 2 million.

"This is really a war at this point and it looks as if the bacteria are winning that war," Hill said.