Shots - Health News
12:00 pm
Tue March 5, 2013

Infections With 'Nightmare Bacteria' Are On The Rise In U.S. Hospitals

Originally published on Thu March 20, 2014 1:34 pm

Federal officials warned Tuesday that an especially dangerous group of superbugs has become a significant health problem in hospitals throughout the United States.

These germs, known as carbapenem-resistant Enterobacteriaceae, or CRE, have become much more common in the last decade, according to the Centers for Disease Control and Prevention. And the risk they pose to health is becoming evident.

"What's called CRE are nightmare bacteria," Dr. Thomas Frieden, director of the CDC, tells Shots. "They're basically a triple threat."

First of all, they are resistant to virtually all antibiotics, including the ones doctors use as a last-ditch option.

Second, these bugs can transfer their invincibility to other bacteria. "The mechanism of resistance to antibiotics not only works for one bacteria, but can be spread to others," Frieden says.

Third, the bacteria can be deadly. Infection with the bacteria "have a fatality rate as high as 50 percent," Frieden says.

Although the resistant bacteria potentially pose a risk to anyone, people whose immune systems are weaker, such as elderly people, children and people who have other health problems, tend to be most susceptible to infection.

If the drug-resistance starts to spread from bacteria that are usually a problem in hospitals to much more widespread causes of infections, the risk could rise even more. "If it spread to things like E. coli, which is a common urinary tract infection, it would be a very serious problem," Frieden says.

The CDC sounded the alarm because of data that show the proportion of bacteria that have this resistance to many drugs has quadrupled in the last decade or so.

CRE cases were reported by 4 percent of hospitals in 2012, up from about 1 percent from about a decade earlier, according to the report. In long-term care hospitals the situation is even worse — about 18 percent have reported cases, the CDC says.

In addition, the proportion of Enterobacteriaceae bacteria that were resistant increased from 1.2 percent in 2001 to 4.2 percent in 2011, the CDC reported.

"And that's for the whole family." says Dr. Arjun Srinivasan, the CDC's associate director for health care-associated infection-prevention programs. "When we look at one member of this family, a bacteria called Klebsiella, which is the most common type of CRE that we see in the United States, resistance there has gone from about 2 percent to over 10 percent. So a dramatic increase in the frequency with which these organisms are being seen in our hospitals in the United States."

Infectious disease specialist Dr. Brad Spellberg, of the Los Angeles Biomedical Research Institute at the Harbor-UCLA Medical Center, likens the situation to the Titanic's ill-fated voyage. "We're not talking about an iceberg that's down the line," he says. "The ship has hit the iceberg. We're taking on water. We already have people dying. Not only of CRE, but of untreatable CRE."

So far, these infections are still relatively rare. And they have been seen only in hospitals.

The big fear is that they'll start to move out of hospitals and into the communities around them. "If CRE spreads out of hospitals and into communities, that's when the ship is totally underwater and we all drown," Spellberg says.

To prevent that from happening, the CDC and others are calling on hospitals to contain CRE. "We can nip this in the bud. But it's going to take a lot of effort on the part of hospitals," Frieden says

The first thing hospitals need to do is test patients to see if they have these bugs. "The basic steps are finding patients with CRE and making sure they are isolated so that they don't spread it to others," Frieden says.

That includes common-sense things like keeping them away from other patients and sterilizing everything they come into contact with.

"We know that this can stop outbreaks. It has helped in Florida. It's helped in other countries," Frieden says. "And the good news about this is that it still hasn't spread so widely that we can't stop it."

And doctors have to use antibiotics more carefully to prevent more germs from developing into dangerous superbugs.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

AUDIE CORNISH, HOST:

From NPR News, this is ALL THINGS CONSIDERED. I'm Audie Cornish. A warning today from federal health officials - the threat is growing rapidly from an especially dangerous group of bacteria called superbugs. The Centers For Disease Control and Prevention wants hospitals to step up efforts to prevent these infections. In a few minutes, we'll hear how one hospital handled a superbug outbreak, but first, NPR's Rob Stein explains the CDC's findings.

ROB STEIN, BYLINE: The warning is being prompted by a relatively new type of superbug called CRE. Dr. Tom Frieden of the CDC says these germs are about as bad as any superbug gets.

TOM FRIEDEN: What's called CRE are nightmare bacteria. They're basically a triple threat.

STEIN: A triple threat because, first of all...

FRIEDEN: Not only are they resistant to most or sometimes all antibiotics, but second, they have fatally rate as high as 50 percent.

STEIN: And if that's not bad enough, these bugs can spread their invincibility to other bacteria.

FRIEDEN: They can spread the infection not only from patient to patient, but from bacteria to bacteria. So, the mechanism of resistance to antibiotics not only works for one bacteria, but can be spread to others.

STEIN: That means the danger could easily start to spread from infections that are only usually found in hospitals to those that are much more common.

FRIEDEN: If it spread to things like e coli, which is a common urinary tract infection, it would be a very serious problem.

STEIN: Now the reason the CDC is sounding the alarm today is because of some new data, data that shows a proportion of bacteria that has this resistance has quadrupled in the last decade or so. Arjun Srinivasan of the CDC says it's gone from about one percent to about 4 percent.

ARJUN SRINIVASAN: That's for the whole family. When we look at one member of this family, a bacteria called klebsiella, which is the most common type of CRE that we see in the United States, resistance there has gone from about two percent to over 10 percent. So a dramatic increase in the frequency with which these organisms are being seen in our hospitals in the United States.

STEIN: In fact, the proportion of hospitals that have seen cases has also quadrupled from about one percent to four percent. And it's even a bigger problem at hospitals that care for patients long term.

SRINIVASAN: When we look at those long term acute care hospitals that have seen one of these CRE organisms, it's actually close to 17 percent.

STEIN: Other experts agree the situation is alarming. Brad Spellberg is an infectious disease expert at the Harbor-UCLA Medical Center. He likens the situation to the Titanic.

BRAD SPELLBERG: We're not talking about an iceberg that's down the line. The ship has hit the iceberg. We're taking on water. We already have people dying, not only of CRE, but of untreatable CRE.

STEIN: The good news is that, so far, these infections are still relatively rare and so far, they are only occurring in hospitals. The big fear is that they'll start spreading out of hospitals into the communities around them.

SPELLBERG: If CRE spreads out of hospitals and into communities, that's when the ship is totally under water and we all drown.

STEIN: To prevent that from happening, the CDC's Tom Frieden and others are calling on hospitals to contain CRE.

FRIEDEN: We can nip this in the bud, but it's going to take a lot of effort on the part of hospitals.

STEIN: The first thing hospitals need to do is test patients to see if they have these bugs.

FRIEDEN: The basic steps are finding patients with CRE and then making sure that they're isolated, so that they don't spread it to others.

STEIN: That includes common sense things like keeping them away from other patients and sterilizing everything they come into contact with.

FRIEDEN: We know that this can stop outbreaks. It has helped in Florida. It's helped in other countries, and the good news about this is that it still hasn't spread so widely that we can't stop it.

STEIN: And doctors have to use antibiotics more carefully to prevent more germs from developing into dangerous superbugs. Rob Stein, NPR News. Transcript provided by NPR, Copyright NPR.

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