By: Beatrisa Popovitz, Staff Editor
For the past decade, antibiotic resistant bacteria have been a growing concern in healthcare. Over the last few months, there has been a great deal of media attention surrounding strains of drug resistant bacteria in hospitals across the United States. Most recently, there has been an increased effort to raise awareness of deadly infections attributed to carbapenem-resistant Enterobacteriaceae (CRE), and an urgency to implement a public health intervention that prevents and retards the spread of infection. Dr. Tom Frieden, the director of the Centers for Disease Control and Prevention, described CRE bacteria as a triple threat through resistance, mortality, and spread of disease.1 They are resistant to all or nearly all antibiotics, they have high mortality rates, killing one in every two patients with CRE bloodstream infections, and they easily transfer antibiotic resistance to other bacteria, making spread of infection all the more frequent and dangerous.2
Enterobacteriaceae, like Klebsiella and E. coli, are components of the body’s natural gut flora, but have the potential to cause infection in other organs and organ systems outside of the gut region. In addition, certain types of bacteria may become resistant to antibiotics via various mechanisms, such as genetic mutation or attainment of antibacterial resistance from other bacteria via the conjugation process, which transfers genes encoding for antibacterial resistance from one bacterium to another.3 This antibiotic resistance is largely attributed to the growing trend of overuse and misuse of antibiotics. The reason why this deadly CRE infection is dominant in healthcare settings like hospitals and nursing homes is due to the fact that it targets individuals who are already being treated for other conditions. Thus, the greatest risk lies with patients on long-term antibiotic treatments. The CRE find invasive gateways through the lungs, urinary tract, and bloodstream, rendering patients who are on ventilators, bladder catheters, or IV catheters susceptible to CRE infection.5 Also, CRE spread easily via person-to-person contact within the healthcare setting.
Despite the fact that the CDC has recently found growing concern for CRE infections, this infection is not an uncommon phenomenon in our nation’s healthcare history. In the past decade, healthcare facilities in 42 states have been linked to CRE infections. In the past year, approximately 4% of hospitals and about 18% of long-term acute care hospitals in the United States had at least one patient with a CRE infection.6 The former statistic increased by 3% since 2001.1 The increase in prevalence and the dire consequences of the CRE infections have led the CDC to implement serious precautionary and preventative measures, including healthcare provider adherence to the 2012 CRE Toolkit.
This Toolkit provides healthcare providers with a guided approach to prevention and handling of CRE infection cases in their healthcare facilities. Some key recommendations include the enforcement of infection control precautions, grouping infected patients together, using antibiotics wisely, and screening patients to determine if they may be carrying CRE.7 Access to the Toolkit can be found on the CDC’s website. In addition, the website also features an extensive display of information concerning health care provider detection of CRE infections. Prevention is most often stressed because CRE are resistant to a wide range of antibiotics, which limits treatment options. CRE may however show susceptibility to a couple of antibiotics, and treatment is usually given on a case-by-case basis.8
New advancements in technology, such as germ-zapping robots, are rolling into healthcare facilities fully loaded in the war against superbugs that are difficult to treat. These germ-zapping robots have the ability to sterilize hospital surfaces and sanitize rooms by delivering ultraviolet light or hydrogen peroxide vapors. These machines can surely disinfect, but are rather costly, fairly new, and have not yet been proven to completely prevent infections and/or deaths.9 In addition, it is much easier to combat bacteria like clostridium difficile as opposed to Methicillin-Resistant Staphylococcus Aureus (MRSA) and CRE, so the cost-effectiveness of acquiring such machinery in healthcare facilities is often questionable.
For now, awareness and prevention appear to be the most underscored methods of combating infections caused by the CRE superbugs. Healthcare providers, patients, and associated staff in healthcare facilities are urged to take part in the initiative to halt the spread of these infections by practicing proper sanitizing techniques and adhering to CDC guidelines.
- Shelton, Deborah L. “Antibiotic-resistant Bacteria Called CRE Small in Number but Seen as Deadly Threat.” Chicago Tribune. N.p., 19 Mar. 2013. Web. 29 May 2013. <http://articles.chicagotribune.com/2013-03-19/health/ct-met-superbugs-cre-20130319_1_carbapenem-resistant-urinary-tract-infections-antibiotic-resistant-bacteria>.
- “New CDC Vital Signs: Lethal, Drug-resistant Bacteria Spreading in U.S. Healthcare Facilities.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 13 Mar. 2013. Web. 29 May 2013. <http://www.cdc.gov/media/dpk/2013/dpk-vs-hai.html>.
- “General Background: About Antibiotic Resistance.” Tufts University. N.p., 2012. Web. 29 May 2013. <http://www.tufts.edu/med/apua/about_issue/about_antibioticres.shtml>.
- Grady, Denise. “Deadly Bacteria That Resist Strongest Drugs Are Spreading.” The New York Times. The New York Times, 05 Mar. 2013. Web. 29 May 2013. <http://www.nytimes.com/2013/03/06/health/deadly-drug-resistant-infections-rise-in-hospitals-report-warns.html?_r=0>.
- “Carbapenem-resistant Enterobacteriaceae (CRE).” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 09 May 2013. Web. 29 May 2013. <http://www.cdc.gov/hai/organisms/cre/>.
- “Making Health Care Safer.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 05 Mar. 2013. Web. 29 May 2013. <http://www.cdc.gov/vitalsigns/HAI/CRE/index.html>.
- “CDC: Action Needed Now to Halt Spread of Deadly Bacteria.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 05 Mar. 2013. Web. 29 May 2013. <http://www.cdc.gov/media/releases/2013/p0305_deadly_bacteria.html>.
- “General Information about CRE.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 05 Mar. 2013. Web. 29 May 2013. <http://www.cdc.gov/hai/organisms/cre/cre-patientgeneral.html>.
- Stobbe, Mike. “Germ-zapping ‘robots’: Hospitals Combat Superbugs.” Yahoo! News. Yahoo!, 29 Apr. 2013. Web. 31 May 2013. <http://news.yahoo.com/germ-zapping-robots-hospitals-combat-superbugs-140922678.html>.