In this month’s issue of the Centers for Disease Control and Prevention (CDC) Vital Signs, government health officials examine a public health issue that is still relatively uncommon, but very serious–Carbapenem-Resistant Enterobacteriaceae (CRE).
During a press briefing Mar. 5, director of the Centers for Disease Control and Prevention, Dr. Tom Frieden discussed serious public health issue.
Dr. Frieden noted that one of the jobs of the CDC is to let people know about health threats before they become widespread. CRE fits that category perfectly.
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 Director Frieden. “Doctors, hospital leaders, and public health, must work together now to implement CDC’s “detect and protect” strategy and stop these infections from spreading.”
The CRE encompass a large group of microorganisms called Enterobacteriaceae, which include bacterium like E. coli and Klebsiella.
Particularly over the past decade, some of these bacteria have become resistant to a group of antibiotics known as carbapenems, often referred to as last-resort antibiotics.
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.
According to the Vital Signs 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.
What can healthcare providers do?
Frieden answered that question Tuesday saying by using the “Detect and Protect” approach to implement CRE prevention programs.
He describes detect and protect as follows:
There are six important steps that healthcare providers can take. The first two are in the “detect” part of this equation. The last four are in the “protect” part of it.
The first two are, first, know if your patients have CRE, and request immediate alerts from your laboratory every time they identify a patient with CRE. Second, when either receiving or transferring patients, make sure to ask and find out if the patient you’re receiving has CRE.
Third, in the “protect” area, protect your patients from CRE by following contact and other precautions whenever you’re getting patients with CRE, so you don’t inadvertently spread their organism to others. Fourth, whenever possible, have specific rooms, equipment, and staff equipped for CRE patients. That reduces the chance CRE will spread from one patient to others. Fifth, take out temporary medical devices like catheters as soon as possible. And finally, and very importantly, prescribe antibiotics carefully.
Unfortunately, half of all of the antibiotics prescribed in this country are either unnecessary or inappropriate. Overuse and misuse increases drug resistant infections and that results in longer inpatient treatment, higher costs, and poorer patient outcomes. Many antibiotics have been shown to increase the risk of getting CRE.
CRE outbreaks in Colorado and Florida were successfully stopped after health departments and health facilities put into place CDC recommendations.
“We have seen in outbreak after outbreak that when facilities and regions follow CDC’s prevention guidelines, CRE can be controlled and even stopped. As trusted health care providers, it is our responsibility to prevent further spread of these potentially deadly bacteria”, said Michael Bell, MD, Acting Director of CDC’s Division of Healthcare Quality Promotion.
Listen to Dr. Frieden’s press briefing here.
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