March 6, 2013
Antibiotic-Resistant Bacterial Infections On The Rise In Hospitals, CDC Warns
Lawrence LeBlond for redOrbit.com - Your Universe Online
While bacterial infections are a relatively common occurrence throughout US hospitals, federal health officials have warned they are on the rise and becoming more resilient, and are urging all healthcare facilities around the country to be on guard.
The US Centers for Disease Control and Prevention (CDC) released its new Vital Signs report on Tuesday, reporting that so-called carbapenem-resistant Enterobacteriaceae (CRE) “superbugs” are increasingly resistant to even the strongest antibiotics and are behind the death of half of all patients who develop bloodstream infections from them. While cases are still unusual, they have been on the rise over the past decade.
Thomas Frieden, MD, MPH, director of the CDC, said in a news conference that CRE is potentially a “nightmare bacteria” because the organisms, which have been found to be antibiotic-resistant, can be very deadly when they invade the bloodstream.
However, he did stress that infections caused by CRE are preventable with proper infection-control measures put in place, such as thorough handwashing and sanitization. "We still have time to stop CRE," he added.
Frieden called on everyone involved in the healthcare industry to band together to halt the spread of CRE and other infections. “Our strongest antibiotics don´t work, and patients are left with potentially untreatable infections,” he said.
Although CRE has yet to spread to the wider community, the dangerous nature of bacteria makes it a “triple threat,” said Frieden.
First, it is resistant to all antibiotics known. Second, it kills 1 in 2 people that develop a bloodstream infection. And third, CRE can transfer its antibiotic resistance to other bacteria within the family, potentially making them untreatable as well, Frieden explained.
An example is the Klebsiella outbreak at a National Institutes of Health (NIH) facility that began nearly two years ago, sickening 19 people and killing 12. Seven of the deaths were directly attributed to Klebsiella pneumoniae. Klebsiella has been known to “spread the genes that destroy our last antibiotics to other bacteria, such as E. coli, and make E. coli resistant to antibiotics also,” Frieden said.
Enterobacteriaceae resistant to antibiotics has increased nearly fourfold in the past 10 years, from 1.2 percent in 2001 to 4.2 percent in 2011, according to data reported to the CDC. The strain that caused the NIH outbreak increased sevenfold in the past decade, according to the CDC.
While no data was shared for fatalities, the CDC´s National Healthcare Safety Network (NHSN) database showed that 4.6 percent (nearly 200) of hospitals and healthcare facilities in the first half of 2012 reported at least one patient infected with CRE.
In a separate finding, the privately operated Surveillance Network-USA database, which collects data from 300 clinical labs around the country, reported a CRE prevalence of 1.4 percent in 2011, up from zero in 2001.
Alexander Kallen, MD, and colleagues found in a pilot program involving labs in three US cities, that 92 percent of CRE cases over a five-month period in 2011 were from patients with “substantial healthcare exposures.”
Part of the trouble with getting a good measure of how many CRE infections that may exist, and the actual scope of the crisis, is that only six states require hospitals and healthcare facilities to report CRE infections to state health officials. These states include Colorado, Minnesota, North Dakota, Oregon, Tennessee and Wisconsin.
Enterobacteriaceae are a family of more than 70 bacteria, including E. coli and K. pneumoniae. Over time, some of these bacteria become resistant to carbapenems, usually considered last-resort antibiotics. Since 2001, CRE has gone from an infection in a single healthcare facility to facilities in at least 42 states nationwide, according to the CDC report.
Most infections occur in patients who are receiving care for serious conditions, and who have weakened immune systems. Many of these patients have catheters or ventilators, which make it easy for bacteria “to get deeply into a patient´s body,” Frieden said.
These germs themselves spread to patients most often from the hands of doctors, nurses and other healthcare professionals who do not always sanitize properly before coming into contact with the patient.
Since even patients can carry the bacteria with them from one location to another, the CDC is calling on healthcare facilities to adopt an aggressive “Detect and Protect” program.
Better sanitizing practices would go a long way in controlling outbreaks. Patients who are hospitalized should ask their doctors and nurses to wash their hands before touching them. And patients should not always demand antibiotics for their illnesses.
“Not all fevers require antibiotics. The more we use antibiotics, the more we encourage the spread of antibiotic resistance,” Frieden said in a statement to the Washington Post.
"We have seen in outbreak after outbreak that when facilities and regions follow CDC's prevention guidelines, CRE can be controlled and even stopped," Dr. Michael Bell, acting director of CDC's Division of Healthcare Quality Promotion, told CBS News. "As trusted health care providers, it is our responsibility to prevent further spread of these deadly bacteria."