The latest "superbug"

The March, 2013 edition of Vital Signs, a publication of the Centers for Disease Control and Prevention, reported on a concerning increase in the prevalence of a drug-resistant bacteria in health care facilities ( www.cdc.gov/vitalsigns/hai/cre / ). Carbapenem-resistant Enterobacteriaceae (CRE) became a hot news story this week with the report that they are becoming more common and pose a significant challenge to high risk patients because of their resistance to last-resort antibiotics. Among all infections from gut bacteria, resistance has risen from 1% in 2001 to 4% in 2012. Forty-two states have had such cases, most common in the Northeast. It is important to keep in mind that these infections have shown no evidence of spreading into the community, and that they are not a risk unless we develop a serious illness which exposures us to CRE and lowers our immune resistance.

CRE are part of a family of bacteria that are a normal part of all of our digestive systems. When they escape the digestive system and get into our bladder, blood or other areas they can cause significant or even life threatening infections.  However, as above, these infections are not a risk in the community at large, or in outpatient health facilities. Almost all CRE infections occur in elderly hospitalized patients who have prolonged hospital stays which include the insertion of intravenous lines, urinary catheters or other foreign bodies as well as treatment with antibiotics for community acquired infections.  Of concern is the CRE easily transfer their antibiotic resistance to other bacteria, which would raise the potential of more widespread infections with resistant organisms.

It is important to note the strict adherence to infection control guidelines can lower the risk of these infections. When faced with a multihospital outbreak, Israel was able to decrease CRE infection rates in all 27 of its hospitals by more than 70% by implementing a coordinated prevention program.

There are three cornerstones to controlling the rise of this infection:

1.Strict adherence to hand washing guidelines by all medical personnel and hospital visitors

2.Avoiding, or removing as soon as possible, any catheter, line, or foreign body during the course of patient care

3.“Antibiotic stewardship”- Patterns of antibiotic use show an alarming frequency of inappropriate antibiotic prescribing-particularly for colds and other viral respiratory tract infections. Physicians need to prescribe antibiotics wisely (www.cdc.gov/getsmart/healthcare) and patients should be educated on the uselessness of antibiotics in most outpatient conditions. 

The story of bacterial resistance to antibiotics is far from over.  Gonorrhea, staph, strep and even TB germs have all shown alarming changes in their susceptibility to antibiotics. There are no new classes of antibiotics in the “pipeline” that are expected soon. So wash your hands, stay healthy, and only take antibiotics if you have a definite bacterial (as opposed to viral) infection.