Antibiotic Resistance—an Alarming Health Care Issue - Statistical Data Included

AORN Journal, July, 2000 by Carolyn Twomey

LEGAL ISSUES

Infectious disease is a global issue. Control at the national level is encumbered, and the United States' response to infectious diseases is governed by jurisdictional boundaries. Worldwide microbial resistance issues, however, are creating the need for an international legal role. Despite the fact that surveillance and reporting of resistance are critical, efforts are underfunded at local, state, and national levels. Moreover, legal duty does not necessarily result in compliance.

Surveillance and reporting have to be balanced with patient privacy issues. Different legal systems handle such issues in vastly different ways. Although patient confidentiality is a significant issue in the United States, Europe strictly forbids the processing of health information without patients' written permission. In addition, European law permits states to withhold personal data from those who cannot comply with the protection of this data. This difference between the United States and European reporting is an example of how complicated the international approach to microbial resistance issues will be.

Another frightening component of infectious disease is biological warfare. Considerable concern exists about the potential use of resistant microorganisms in warfare because resistance inhibits defenses against a biological attack. The US Department of Defense monitors suspicious outbreaks of resistant infectious disease because of its concern about biological weapons.(54)

Many other legal issues are at stake, including the

* ability to detain or isolate infected people,

* judicious use of antimicrobial agents,

* widescale funding of research and development of new antimicrobial agents,

* pharmaceutical company concerns of loss of intellectual property rights,

* regulatory approval procedures, and

* antitrust law limitation on collaborative research and development.

Achieving the public health objectives of antimicrobial resistance involves legal considerations and decisions. National and international laws are imperative to the public health mission in every country.(55)

CONCLUSION

Correct identification of infectious strains is critical. Reporting of MRSA, VRE, and vancomycin intermittent-resistant S. aureus to the CDC is essential. Scientists need to implement the latest CDC recommendations for detecting staphylococci with reduced vancomycin susceptibility. The CDC defines its role as frontline observers waiting to sound the alarm.(56)

Although a large complement of federal agencies (eg, the US Department of Defense, Heath Care Financing Administration) are becoming involved in the effort to fight antibiotic resistance, a newly formed antibiotic resistance task force has been headed by three key agencies: the CDC, the National Institutes of Health, and the FDA. Their impact likely will reach well beyond the warnings and guidelines that have been issued in recent years.(57)

Another recent trend that must be addressed is the growing use of antibacterials in individual homes. This includes products (eg, soaps, kitchenware) that have been impregnated with antibacterials. Some researchers believe there is no evidence that these products prevent infection. Moreover, these products may alter the natural bacteria population by killing susceptible bacteria and encouraging the growth of resistant strains. Resistant strains are abundant in hospitals where these antibacterials are truly necessary.(58)