Antibiotic resistance, described as a “growing public health concern worldwide” by the FDA, is popping up in local health care facilities in Western Washington in the form of potentially dangerous, drug-resistant bacteria.
KIRO 7 discovered four cases of a specific type of antibiotic resistant bacteria at Everett Center, a nursing rehabilitation facility on 112th Street Southwest in Everett.
The bacteria is known as carbapenem-resistant Acinetobacter baumannii, or CRAB. It is a specific kind of bacteria resistant to one of the strongest antibiotic classes called carbapenems, which doctors say are often used as a last resort.
“It’s kind of scary, isn’t it? You know, all the best drugs in the world can’t stop these germs,” Randy Eide, husband of a patient at the facility, said.
“When you told me that, I was like, whoa, no,” Dani Haslan, wife of a patient at the facility, said.
According to public records obtained by KIRO 7 from Snohomish County, two of the patients died in early 2019 and two others were colonized with the bacteria, though the Washington Department of Health said it was unclear to them how the two patients died.
“I don't know whether they died with it, or if they died from it,” Dr. Marisa D’Angeli, Washington state Department of Health medical epidemiologist, said.
Both Haslan and Eide were surprised they had not heard about the cases. Haslan’s husband had only been at the facility for a couple of weeks, but Eide said his wife had been there since last fall.
“I wish somebody had told me that,” Eide said. “I don’t like to be in the dark on stuff like this and patients shouldn’t be in the dark.”
In fact, KIRO 7 only discovered the deaths when they were mentioned in public records we requested from Snohomish County on a completely different subject.
“In this situation we've uncovered a problem that we didn't know we had,” D’Angeli said of CRAB, which the CDC called a serious threat in its report Antibiotic Resistance Threats in the United States, 2013.
“Antibiotic resistance is a growing problem, and it's a problem not only in the United States but all around the world,” she said. “We are basically running out of antibiotics that will be effective.”
In March of 2019, the state acquired a new test that can detect OXA-23 CRAB and other similar bacteria. It went back and tested samples from 2017 and 2018, as well.
In 2017, there were 30 CRAB cases across the state. Two in Pierce County were OXA-23, the specific type found at the Everett facility. In 2018, there were 28, including 11 OXA-23 across several counties. And in the first half of this year, there were 19 CRAB cases with the four OXA-23 in Snohomish County.
“I do believe there was likely in facility transmission but we really don’t know how it was spread,” D’Angeli said.
So why didn't people like Randy Eide know about it?
“Are [people] able to find out if there have been previous clusters at these facilities?” KIRO 7 reporter Linzi Sheldon asked.
“There is no database that captures that information,” Dr. D’Angeli said. “It's not mandated to be submitted, so there may be cases happening that we're not aware of.”
KIRO 7 reached out to Genesis Healthcare, which runs the Everett facility.
They told us in part that they had “notified all patients on the affected unit” and that “flyers were distributed and posters were posted throughout the building” for an “information session.”
They also added that "we have no information that anyone died from the CRAB bacteria,” but it's unclear if they would have been notified.
Tracking the cases is tricky, as the facilities are not required by law to report the cases. Symptoms of an infection can vary depending on the vulnerability of a patient.
This particular bacteria, OXA-23 CRAB, has a plasmid on it that can transfer its antibiotic resistance not only to its “children,” but also to any other bacteria it rubs up against, D’Angeli said.
“OXA-23 CRAB might cause symptoms of pneumonia in one patient and might cause symptoms of a urinary tract infection in another patient,” she said, adding that it doesn’t usually cause any harm for healthy people.
People can also be carriers of the bacteria, which can cause an infection in the future if that patient becomes medically vulnerable and an antibiotic is used.
In the case of Everett Center, D'Angeli said they advised the facility on how to prevent future infections, although it was already making improvements.
And, she said, there's a new requirement for nursing homes as of this month.
She said they have to now employ someone "who is specifically trained in infection prevention and works at least part time in the facility" and that the person is "incorporating their work into the quality program."
That's something hospitals like Harborview Medical Center already have.
Dr. John Lynch is medical director of Harborview’s Infection Control, Antibiotic Stewardship and Employee Health programs.
“We try to really focus on infection prevention bedrock principles -- washing your hands,” he said. “If people do have one of these things, wearing our gowns and gloves, so that we don’t risk transmitting to other patients in our facility.”
Lynch said they test any patients coming from outside of the U.S. who have been hospitalized in the last year. They also monitor patients within the hospital who are on specific antibiotics.
“What we really want to do is to not give antibiotics inappropriately,” he said.
Otherwise, they're wiping out good bacteria, which allows these antibiotic resistant bacteria to thrive.
But at a nursing facility, what can you do to protect yourself or a loved one?
D'Angeli recommends checking the facility on the Nursing Home Compare website; asking about their infection prevention program; reminding health care workers to wash their hands; and making it easy for staff to clean the room properly.
“Move things that are in the way,” she said. “Encourage them to come close to the bedside and clean the bedside table and the bed rails and stuff like that.”
Family members of patients, like Randy Eide and Dani Haslan, are concerned but also hopeful.
“As for cleaning, they could do a lot better job -- there's no question in my mind,” Eide said.
"He's been through so much," Haslan said of her husband. "I hope that they've got this under control."
In April this year, the state Department of Health asked all labs in Washington to submit CRAB cases, which will help them track the bacteria better as part of their overall antibiotic-resistant bacteria surveillance program.
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