In last week’s blog I discussed “superbugs”, a term given to bacteria that evolve to become resistant to some of the most commonly-used antibiotics. Drug resistant bacteria are a growing concern among healthcare professionals and the causes are partially related to overuse of antibiotics in our environment.
Today, I’d like to focus on one specific “superbug”, Carbapenem-Resistant Enterobacteriaceae, or CRE for short. It’s a deadly organism that resists treatment and is on the rise worldwide.
Enterobacteriaceae are microbes from a family of bacteria causing such common ailments as respiratory, intestinal and urinary tract infections.
Carbapenem is an antibiotic that has been used in the United States since 1985. Bacterial resistance occurs when specific bacteria evolve to develop an enzyme that makes them resistant to carbapenem. Such resistant infections are labeled as CRE.
CRE is difficult, and at times impossible, to treat since carbapenem is often the drug of last resort for certain bacterial infections, including e-coli and some pneumonia varieties.
Bacterial resistance to carbapenem was uncommon until about ten years ago. Since then, there has been a four-fold increase in resistance to treatment. When resistance occurs, there are simply no other antibiotics effective against these infections, and the mortality rate for CRE has been reported as high as 50%.
The Centers for Disease Control and Prevention (the CDC) estimated that almost 92% of CRE occurs during hospitalization. That makes healthcare institutions the primary focus for prevention.
In 2012, the CDC developed a CRE Tool Kit for healthcare professionals and institutions to provide guidelines for prevention. The top four facility-level prevention strategies included hand hygiene (alcohol-based hand rubs), patient contact precautions, education of personnel and the proper use of devices associated with CRE (such as, venous and urinary catheters).
When a New York area hospital implemented the CDC’s CRE guidelines, that hospital reduced the occurrence of CRE by 50%. The country of Israel implemented similar guidelines in all of its 27 hospitals and reduced the incidence of CRE by 70% in one year.
CRE is on the rise! The CDC states that it is spread by improper hand sanitization, casual contact with affected patients, and the indiscriminant use of medical devices. The spread takes on regional significance when affected patients receive care in several different healthcare settings—such as, transitioning from a hospital to a short-term or long-term care facility. In this way, the affected patient contaminates several facilities with the same antibiotic-resistant infection.
The simple solution is for healthcare institutions to follow the CDC’s guidelines for hand and device hygiene and to implement proper patient contact precautions. Although CRE will not be eradicated until new, more effective antibiotics are available, the incidence of CRE would be greatly reduced.
Thoughts? Comments? I’d love to hear them!