HIV and ID Observations

Right there, on the homepage of today’s New York Times, our national paper of record — Sunday edition, no less! — appears this headline:

A Mysterious Infection, Spanning the Globe in a Climate of Secrecy

Most of this piece is about Candida auris, the highly resistant fungus that targets our most vulnerable patients — those with weakened immune systems due to extremes of age, comorbid medical problems, cancer chemotherapy, or immunosuppressive drugs.

The authors do an excellent job bringing attention to the seriousness of the problem. They provide some theories about its origin and cite the many challenges each Candida auris case brings to hospital workers, in particular those in charge of Infection Control.

But there’s a second message in this piece, one highlighted by the difference between the online headline and the one in print.

Online:  A Mysterious Infection, Spanning the Globe in a Climate of Secrecy
Print:  Fungus Immune to Drugs Quietly Sweeps the Globe

It’s that Climate of Secrecy phrase, implying there’s a widespread cover-up effort.

Indeed, there’s a distinct tone of blame in the article directed squarely at institutions that failed to disclose problems with Candida auris. One person quoted likened it to a restaurant failing to disclose that it had a food poisoning outbreak.

But with the caveat that I don’t work at the institutions cited in the article, I emphatically wish to state that we ID specialists strongly welcome all publicity about the seriousness of antimicrobial resistance.

In fact, if you want two messages about which we have 100% unanimity, here they are:

1. Vaccines work, prevent illness, save lives, and save money — the risks are vastly outweighed by their many benefits.
2. The overuse of antimicrobial agents leads to a dangerous increase in drug-resistant microorganisms, and this is a huge local, national, and global threat.

Read what Infection Control specialist Dr. Dan Diekema wrote after he saw the piece in the Times — he was “Happy to see” that this important issue had risen to such prominence:

Happy to see that an emerging, antimicrobial-resistant, healthcare-associated pathogen has made the FRONT PAGE of the NYT! The reporters do a good job placing C. auris in larger context..@PaulSaxMD @mike_edmond @eliowa 1/9 https://t.co/OH1ioEWJRT

— Dan Diekema (@dan_diekema) April 6, 2019

He (and all of us) are even happier that there’s another piece in the Times on antibiotic resistance, here describing how the combination of antibiotic overuse, crowding, and poor sanitation inexorably drives up resistance rates in low and middle income countries.

So, if there’s a cover-up about this important problem, it’s not coming from us ID doctors.

One last point — while I am all for transparency and disclosure if it improves patient safety, the public must realize that having patients with drug-resistant infections within the walls of a hospital by no means proves that these clinicians and Infection Control departments provide substandard care.

As noted above, it’s frequently the sickest, most complex, and vulnerable patients who develop these infections. Often they are transferred from other institutions after prolonged hospitalizations, with many weeks of antibiotic exposure before they even reach our inpatient wards, and they already harbor resistant bugs.

It would be a shame if tertiary-care hospitals viewed mandatory disclosures of resistant infections as a disincentive for providing care to these patients, who arguably need advanced care the most.

Meanwhile, here’s a wonderful summary of some key learning points about Candida auris — presciently sketched out by cartoonist-MD Dr. Grace Farris a couple of weeks before the Times piece was published. Thank you, Grace!