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CDC sounds alarm about incidence of CRE infections

Tuesday March 5, 2013
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Carbapenem-resistant Enterobacteriaceae have become increasingly resistant to last-resort antibiotics during the past decade, and more hospitalized patients are getting lethal infections that, in some cases, are impossible to cure, according to a report from the Centers for Disease Control and Prevention.

The CDC said the findings, published in the March issue of Vital Signs, are a call to action for the entire healthcare community to work urgently — individually, regionally and nationally — to protect patients. During just the first half of 2012, almost 200 hospitals and long-term acute care facilities treated at least one patient infected with these bacteria.

CRE kill up to half of patients who get bloodstream infections from them, according to the report. In addition to spreading among patients, often on the hands of healthcare 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. 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," CDC Director Tom Frieden, MD, MPH, said in a news release. "Doctors, hospital leaders, and public health [officials] must work together now to implement CDC's 'detect and protect' strategy and stop these infections from spreading."

Enterobacteriaceae are a family of more than 70 bacteria, including Klebsiella pneumoniae and E. coli, that normally live in the digestive system. Over time, some of these bacteria have become resistant to a group of antibiotics known as carbapenems, often referred to as last-resort antibiotics. During the last decade, the CDC has tracked one type of CRE from a single healthcare facility to healthcare facilities in at least 42 states. In some medical facilities, these bacteria already pose a routine challenge to healthcare professionals, according to the report.

Although CRE bacteria are not yet common nationally, the percentage of Enterobacteriaceae that are CRE increased by fourfold in the past decade, according to the report. A resistant form of Klebsiella pneumoniae has shown a sevenfold increase in the last decade. Northeastern states report the most cases of CRE in the United States.

During the first half of 2012, 4% of hospitals treated a patient with a CRE infection, according to the report. About 18% of long-term acute care facilities treated a patient with a CRE infection during that time.

In 2012, the CDC released a CRE prevention toolkit with in-depth recommendations for hospitals, long-term acute care facilities, nursing homes and health departments.

Key recommendations include enforcing use of infection control precautions (standard and contact precautions); grouping patients with CRE together; dedicating staff, rooms and equipment to the care of patients with CRE, whenever possible; having facilities alert each other when patients with CRE transfer back and forth; asking patients whether they recently have received care somewhere else (including another country); and using antibiotics wisely

In addition, the CDC recommends screening patients in certain scenarios to determine whether they are carrying CRE. Because of the way CRE can be carried by patients from one healthcare setting to another, facilities are encouraged to work together regionally to implement CRE prevention programs.

These core prevention measures are critical and can significantly reduce the problem today and in the future, the CDC stated. In addition, continued investment into research and technology, such as a testing approach called advanced molecular detection, is critical to further prevent and more quickly identify CRE.

In some parts of the world, CRE appear to be more common, and evidence shows they can be controlled. Israel recently employed a coordinated effort in its 27 hospitals and dropped CRE rates by more than 70%, according to the CDC. Several facilities and states in the U.S. have seen similar reductions.

"We have seen in outbreak after outbreak that when facilities and regions follow CDC's prevention guidelines, CRE can be controlled and even stopped," said Michael Bell , MD, acting director of the CDC's Division of Healthcare Quality Promotion. "As trusted healthcare providers, it is our responsibility to prevent further spread of these deadly bacteria."

To read the Vital Signs report, part of the Morbidity and Mortality Weekly Report for the week ending March 8, visit www.cdc.gov/mmwr/preview/mmwrhtml/mm62e0305a1.htm?s_cid=mm62e0305a1_w.


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