In the United States, the Centers for Disease Control and Prevention estimated roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria and fungi combined, cause or contribute to 99,000 deaths each year. And a hospital-associated infection of an injured worker being treated for an industrial injury may give rise to an additional claim for benefits as a compensable consequence injury.

And now a new medical study says that the risk now includes untreatable hospital-associated infections that are deadly.

Chinese researchers say an outbreak of severe pneumonia at a Chinese hospital was caused by hypervirulent, highly drug-resistant, and highly transmissible strains of Klebsiella pneumoniae. Their findings were reported recently in the Lancet Infectious Diseases.

The ST11 carbapenem-resistant hypervirulent K pneumoniae strains were identified in five patients in the intensive care unit (ICU) of a hospital in Hangzhou, China. All five patients – who were admitted to the ICU between late February and April of 2016 – had undergone surgery for multiple trauma followed by ventilation and subsequently developed carbapenem-resistant K pneumoniae infections and severe pneumonia that responded poorly to all available antibiotics.

All five patients died of severe lung infection, multi-organ failure, or septic shock.

Analysis of the 21 carbapenem-resistant K pneumoniae strains recovered from the patients indicated that the strains had almost identical antibacterial susceptibility profiles and shared highly similar DNA fingerprints. Further genetic and phenotypic characterization of one representative carbapenem-resistant K pneumoniae isolate from each patient showed that all five belonged to the ST11 lineage, contained several resistance genes, and originated from a single clone.

“Due to acquisition of a virulence plasmid by classic ST11 carbapenem-resistant K pneumoniae strains, these new strains are simultaneously hypervirulent, multidrug resistant, and transmissible, and should therefore be regarded as a real superbug that could pose a serious threat to public health,” the authors write.

In a commentary in the same journal issue, two experts from Rutgers University wrote that the study describes an alarming evolutionary event: plasmid-mediated convergence of multidrug-resistance and hypervirulence in an epidemic cabapenem-resistant K pneumoniae clone.

Though a similar event had been reported before, the new report on five fatal cases characterizes the virulence and resistance plasmids. The two wrote that the transfer of the virulence plasmids raises worries that the organisms might not only cause untreatable hospital infections, but also serious life-threatening ones in the community.

The new findings underscore the need for new effective antibiotics, and new strategies such as vaccines, phage therapy, and gene therapy for battling drug-resistant organisms offer optimism. “However, the reality is that we are now in a crisis,” they wrote, adding the keys to curbing the new hypervirulent strains are early detection and containment with comprehensive infection control measures.

From a claims administration standpoint, one might question the track record of facilities that are used to treat injured workers, and steer clear of facilities with tenacious infection histories. Some of this information is publicly available, but not widely know.

The Healthcare-Associated Infections (HAI) Program is one of two programs in the Center for Health Care Quality of the California Department of Public Health. The Program was created by mandate to oversee the prevention, surveillance, and reporting of HAI in California’s general acute care hospitals. Since 2010, the HAI Program has produced annual public reports of hospital HAI data to inform choices of healthcare consumers and prompt providers to take actions to prevent infections.

The latest 2015 report identifies 2894 infections and predicted an overall infection rate of 4744 which was then allocated to each of the medical facilities by name on the seven page table.  Surprisingly, the Ronald Regan UCLA Medical Center had 149 observed infections, the highest of any facility on the list.  It is likely that claims administrators can manage the risk of a compensable consequence injury caused by hospital-associated infections by periodic scrutiny of these reports and lists and strategies for the management of claims.