Alice M. Brennan was 88, but she didn&#8217t look or act very old.

She lived independently in Lockport, managed her own finances, drove a car and maintained

an active social schedule.

Her daughter, Mary Brennan-Taylor, likes to show a photograph of her mother dancing at a

family wedding last year.

&#8220She had the spirit of an 18-year-old,&#8221 said Brennan-Taylor.

But Alice Brennan&#8217s right leg began to experience pain and swelling in 2009. She was

hospitalized briefly, diagnosed with gout and sent to a nursing home for rehabilitation.

Instead of recuperating from the severe form of arthritis, she deteriorated and died six

weeks after the initial hospitalization.

Her family contends three infections that Brennan developed led to her death.

&#8220What&#8217s most difficult for me is that this was preventable,&#8221 said

Brennan-Taylor.

Brennan&#8217s story illustrates a major challenge in health care.

It was once believed that antibiotics would erase bacterial infections. Instead, overuse

and misuse of the drugs in medicine and on farms is making treatment of infections more

difficult as germs evolve with growing resistance.

An estimated 99,000 deaths associated with infections occur in hospitals alone each year,

according to the federal Centers for Disease Control and Prevention. In recent decades,

infections became so common that they were considered an unavoidable complication of caring

for the sickest patients. Yet many are avoidable.

&#8220We assume that infections are natural, that they emerge out of nowhere because they

often occur in people who are already ill. But infections are transmitted. That means they can

be prevented and these deaths reduced,&#8221 said Ramanan Laxminarayan, the lead investigator

for Extending the Cure, a project examining antibiotic resistance based at Resources for the

Future, a think tank in Washington, D.C.

Patient safety

WNY hospitals with infection rates significantly better or worse than the state average

HospitalBelow-average resultAbove-average result

Buffalo GeneralHeart bypass surgerySurgical ICU

Kenmore MercyHip surgery

MercyHeart bypass surgery

Mount St. Mary'sColon surgery

WCAColon surgery

Women & Children'sPediatric ICU

Source:

New York Health Department report, 2008 statistics

Health care-associated infections in U.S. hospitals

1.7 million cases and 99,000 associated deaths each year

32 percent in urinary tract

22 percent at site of surgery

15 percent in lungs (pneumonia)

4 percent in bloodstream

Source: Centers for Disease Control and Prevention

Hospitals are trying to improve.

Earlier this year, for instance, a project at more than 100 Michigan intensive-care units

reported a 66 percent drop in bloodstream infections from the placement of catheters in veins

after adopting a checklist of infection-control practices, including hand-washing, and

measuring the results.

But potentially fatal infections like the ones linked to Brennan&#8217s death persist

despite the existence of measures to limit the spread of microbes.

In its 2009 quality report to Congress released last month, the Health and Human Services

Department found &#8220very little progress&#8221 on eliminating health care-acquired

infections.

Among five major infections examined, the rate of bloodstream illness following surgery

increased 8 percent from 2006 to 2007, while the rate of post-operative urinary tract

infections from catheters rose 3.6 percent.

There is debate over the quality report&#8217s conclusion about progress that forthcoming

government studies may clarify. But there is little disagreement over the problem of

antibiotic resistance and the specter of making once-treatable diseases untreatable, as if the

era before antibiotics had returned.

&#8220If we use antibiotics more appropriately we will improve our ability to treat

bacterial infections, and if we do a better job of infection control, we will reduce the need

for antibiotics,&#8221 said Laxminarayan.

In a recent study, he and his colleagues found that two common hospital-acquired infections

&#8212 pneumonia and sepsis, a bloodstream illness &#8212 killed 48,000 people and increased

health costs by $8.1 billion in 2006 alone. The research looked at deaths actually caused by

infections, whereas the CDC statistic of 99,000 refers to deaths associated with

hospital-acquired infections.

Laxminarayan said solutions to the problem will require stronger government leadership to

develop new antibiotics, better treatment strategies and community infection-control efforts

that go beyond hospitals.

Brennan&#8217s case illustrates how patients and microbes today travel from facility to

facility.

She was discharged July 17 from Eastern Niagara Hospital (formerly Lockport Memorial) to

the Odd Fellows & Rebekah Rehabilitation and Health Care Center in Lockport for what was

supposed to be two weeks of therapy to help with walking.

However, she began to suffer from hallucinations, incontinence and loss of appetite,

symptoms her daughter contends resulted from a high dose of a muscle relaxant.

Brennan was readmitted Aug. 3 to Eastern Niagara with dehydration and a few days later sent

back to Odd Fellows, where symptoms worsened and grew to include abdominal pain, according to

Brennan-Taylor.

She returned to the hospital around Aug. 10 with a urinary tract infection caused by MRSA,

a bacterium resistant to common antibiotics, said Brennan-Taylor. Her mother was treated with

another antibiotic, vancomycin, but continued to decline. Then tests identified two more

bacterial infections &#8212 clostridium difficile, which causes diarrhea, and

vancomycin-resistant enterococci, which can cause skin wounds.

&#8220My mom fell prey to a fragmented health system and a complacent attitude about

infections,&#8221 said Brennan-Taylor. &#8220People in health care act as if infections are

inevitable, or that this happens all the time, and they can turn it around. It shouldn&#8217t

be something they deal with all the time.&#8221

A state Health Department investigation faulted the hospital for not implementing an

adequate care plan for isolating the patient. A review of Odd Fellows found no evidence to

corroborate Brennan-Taylor&#8217s complaint of inadequate care.

Hospital and nursing home officials declined to discuss the case, citing privacy laws.

In a prepared statement, hospital spokeswoman Carolyn Moore said the hospital maintains an

infection-control program that includes surveillance of inpatients. She said Eastern Niagara

takes the additional step of screening patients at admission for MRSA, which individuals can

carry into a facility. Eugene L. Urban, chief executive officer of Odd Fellows, in a

statement, said the nursing home has not been found to be in violation of any infection-

control standards.

Much of the focus on infections has centered around staphylococcus aureus, a bacterium

commonly carried on the skin or in the nose of healthy people. About 30 percent of healthy

individuals in the community have staph living in their nose but aren&#8217t infected.

Staph can cause an infection, usually minor skin ailments, and outbreaks have become more

common in locker rooms and schools. But another strain of staph bacteria occurs most

frequently in hospitals and nursing homes, where it can cause serious infections in the blood,

lungs and surgery sites.

MRSA, or methicillin-resistant staphylococcus aureus, is the type of staph that is

resistant to common antibiotics. Of the individuals living with staph in their noses, an

estimated 1 percent have the MRSA strain.

The community-acquired strain of MRSA is a growing problem, including in Buffalo.

A study reported this year of Kaleida Health hospitals reflected what is happening across

the country. The rate of suspected community-acquired MRSA in patients increased for adults

from 56 percent in 2003 to 71 percent in 2006, and for children from 26 percent to 64 percent.

Most MRSA occurs in health care facilities, where the bacteria can enter the body through

wounds, catheters and ventilators. Older and weakened patients are especially vulnerable.

&#8220It&#8217s complicated for hospitals because you often can&#8217t differentiate

hospital-acquired MRSA from the community variety,&#8221 said Dr. Chiu Bin Hsiao, lead author

and associate professor of infectious diseases at the University at Buffalo.

MRSA is just one of many antibiotic-resistant pathogens that pose a danger to patients and

that can be spread by skin-to-skin contact or by touching contaminated items. Others include

acinetobacter, pseudomonas aeruginosa and clostridium difficile.

Cases of clostridium difficile are now more common than MRSA in community hospitals,

according to research reported in March at an international conference on health care

infections. These bacteria normally live in the large intestine, but taking antibiotics for

other infections can wipe out the &#8220good&#8221 bacteria in the digestive tract that keep

them from proliferating like weeds on a lawn.

Efforts under way to curb infections include financial penalties by Medicare and private

insurers for preventable episodes in hospitals, screening of patients for MRSA and

hospital-acquired infection reporting by more than half the states.

New York last year began releasing 12 different infection rates for hospitals. No one

facility was found to have a high infection rate across the board, but officials say it&#8217s

premature to draw conclusions.

&#8220The public perception has been that a patient comes into a hospital and gets an

infection. But the problem is much more complex, with different types of infections in

different health care settings,&#8221 said Rachel Stricof, director of the state&#8217s bureau

of health care-associated infections.

One solution is to deny payment to hospitals for some infections, although critics contend

it&#8217s impossible to eliminate all infections. They say the penalties don&#8217t account

for patients who are extraordinarily ill, or for the way patients routinely move through

multiple facilities for care.

Veterans Affairs hospitals began screening patients for MRSA in 2007. The mandated measure

resulted in a decline nationally in transmission of MRSA and new infections, although a recent

study at the VA Medical Center in Buffalo did not find a similar drop in new infections over

the first two years of the program for reasons that remain unclear.

Screening may work against MRSA, but its high cost would impose a huge financial burden on

private hospitals with far more patients, said Dr. John Sellick, lead author of the study and

the medical center&#8217s epidemiologist.

&#8220There are a lot of other infections to control, and hospitals don&#8217t get

reimbursed more for these measures. You have to consider what is the best use of your human

and laboratory resources,&#8221 he said.

Sellick said hospitals should encourage a culture in which the entire staff buys into a

system of infection control.

To Brennan-Taylor, who took her mother&#8217s death hard, what&#8217s needed at a minimum is

a change in thinking about the scale of the problem.

&#8220The deaths are isolated, so they don&#8217t get much attention,&#8221 she said.

&#8220But it&#8217s akin to a jumbo jet crashing every other day.&#8221