Lethal, Drug-re­sis­tant Bac­te­ria Spread­ing in U.S. Health­care Fa­cil­i­ties

Wellness Update - - Health News -

AT­LANTA, Ga. – A fam­ily of bac­te­ria has be­come in­creas­ingly re­sis­tant to last-re­sort an­tibi­otics dur­ing the past decade, and more hos­pi­tal­ized pa­tients are get­ting lethal in­fec­tions that, in some cases, are im­pos­si­ble to cure. The find­ings, pub­lished in the Cen­ters for Disease Con­trol (CDC) and Preven­tion’s Vi­tal Signs report, are a call to ac­tion for the en­tire health care com­mu­nity to work ur­gently – in­di­vid­u­ally, re­gion­ally and na­tion­ally – to pro­tect pa­tients. Dur­ing just the first half of 2012, al­most 200 hos­pi­tals and long-term acute care fa­cil­i­ties treated at least one pa­tient in­fected with th­ese bac­te­ria.

The bac­te­ria, Car­bapenem-Re­sis­tant En­ter­obac­te­ri­aceae (CRE), kill up to half of pa­tients who get blood­stream in­fec­tions from them. In ad­di­tion to spread­ing among pa­tients, of­ten on the hands of health care per­son­nel, CRE bac­te­ria can trans­fer their re­sis­tance to other bac­te­ria within their fam­ily. This type of spread can cre­ate ad­di­tional life-threat­en­ing in­fec­tions for pa­tients in hos­pi­tals and po­ten­tially for oth­er­wise healthy peo­ple. Cur­rently, al­most all CRE in­fec­tions oc­cur in peo­ple re­ceiv­ing sig­nif­i­cant med­i­cal care in hos­pi­tals, long-term acute care fa­cil­i­ties, or nurs­ing homes.

“CRE are night­mare bac­te­ria. Our strong­est an­tibi­otics don’t work and pa­tients are left with po­ten­tially un­treat­able in­fec­tions,” said CDC Di­rec­tor Tom Frieden, M.D., M.P.H. “Doc­tors, hospi­tal lead­ers, and pub­lic health, must work to­gether now to im­ple­ment CDC’s “de­tect and pro­tect” strat­egy and stop th­ese in­fec­tions from spread­ing.” En­ter­obac­te­ri­aceae are a fam­ily of more than 70 bac­te­ria in­clud­ing Kleb­siella pneu­mo­niae and E. coli that nor­mally live in the di­ges­tive sys­tem. Over time, some of th­ese bac­te­ria have be­come re­sis­tant to a group of an­tibi­otics known as car­bapen­ems, of­ten re­ferred to as last-re­sort an­tibi­otics. Dur­ing the last decade, CDC has tracked one type of CRE from a sin­gle health care fa­cil­ity to health care fa­cil­i­ties in at least 42 states. In some med­i­cal fa­cil­i­ties, th­ese bac­te­ria al­ready pose a rou­tine chal­lenge to health care pro­fes­sion­als.

The Vi­tal Signs report de­scribes that although CRE bac­te­ria are not yet com­mon na­tion­ally, the per­cent­age of En­ter­obac­te­ri­aceae that are CRE in­creased by four­fold in the past decade. One type of CRE, a re­sis­tant form of Kleb­siella pneu­mo­niae, has shown a sev­en­fold in­crease in the last decade. In the U.S., north­east­ern states report the most cases of CRE.

Ac­cord­ing to the report, dur­ing the first half of 2012, four per­cent of hos­pi­tals treated a pa­tient with a CRE in­fec­tion. About 18 per­cent of long-term acute care fa­cil­i­ties treated a pa­tient with a CRE in­fec­tion dur­ing that time.

In 2012, CDC re­leased a con­cise, prac­ti­cal CRE preven­tion tool­kit with in-depth rec­om­men­da­tions for hos­pi­tals, long-term acute care fa­cil­i­ties, nurs­ing homes and health de­part­ments. Key rec­om­men­da­tions in­clude: en­forc­ing use of in­fec­tion con­trol pre­cau­tions (stan­dard and con­tact pre­cau­tions) • group­ing pa­tients with CRE to­gether • ded­i­cat­ing staff, rooms and equip­ment to the

care of pa­tients with CRE, when­ever pos­si­ble • hav­ing fa­cil­i­ties alert each other when

pa­tients with CRE trans­fer back and forth • ask­ing pa­tients whether they have re­cently re­ceived care some­where else (in­clud­ing an­other coun­try) us­ing an­tibi­otics wisely

In ad­di­tion, CDC rec­om­mends screen­ing pa­tients in cer­tain sce­nar­ios to de­ter­mine if they are car­ry­ing CRE. Be­cause of the way CRE can be car­ried by pa­tients from one health care set­ting to an­other,

fa­cil­i­ties are en­cour­aged to work to­gether re­gion­ally to im­ple­ment CRE preven­tion pro­grams.

Th­ese core preven­tion mea­sures are crit­i­cal and can sig­nif­i­cantly re­duce the prob­lem to­day and for the fu­ture. In ad­di­tion, con­tin­ued in­vest­ment into re­search and tech­nol­ogy, such as a test­ing ap­proach called Ad­vanced Molec­u­lar De­tec­tion (AMD), is crit­i­cal to fur­ther pre­vent and more quickly iden­tify CRE.

In some parts of the world, CRE ap­pear to be more com­mon, and ev­i­dence shows they can be con­trolled. Is­rael re­cently em­ployed a co­or­di­nated ef­fort in its 27 hos­pi­tals and dropped CRE rates by more than 70 per­cent. Sev­eral fa­cil­i­ties and states in the U.S. have also seen sim­i­lar re­duc­tions.

“We have seen in out­break af­ter out­break that when fa­cil­i­ties and re­gions fol­low CDC’s preven­tion guide­lines, CRE can be con­trolled and even stopped,” said Michael Bell, M.D., act­ing di­rec­tor of CDC’s Di­vi­sion of Health­care Qual­ity Pro­mo­tion. “As trusted health care providers, it is our re­spon­si­bil­ity to pre­vent fur­ther spread of th­ese deadly bac­te­ria.”

For more in­for­ma­tion, visit the CDC web­site to get de­tails on CRE and the preven­tion tool­kit (http://www. cdc.gov/hai/or­gan­isms/cre/cre-tool­kit/in­dex.html).

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