The Centers for Disease Control and Prevention (CDC) are making an urgent appeal to hospitals to take preventive steps to stop the spread of a deadly drug-resistant bacteria before it worsens.
The bacteria, carbapenem-resistant Enterobacteriaceae (CRE), is a family of more than 70 different bacteria that are potentially fatal and commonly transmitted from person to person, often by medical staff with unclean hands.
The risk is highest among patients who are receiving complex or long-term medical care, says Tom Frieden, M.D., director of the CDC, during a March 5 "Vital Signs" telebriefing report.
"CRE are nightmare bacteria," Frieden says in the report. "They pose a triple threat. First, they're resistant to all or nearly all antibiotics, even some of our last-resort drugs. Second, they have high mortality rates. They kill up to half of people who get serious bloodstream infections from them. Third, CRE can easily transfer their antibiotic resistance to other bacteria."
CRE germs are not very common, and the number of cases remains relatively low, but this number is rising. In the first half of 2012, nearly 200 hospitals and long-term acute care facilities treated at least one patient who was infected with CRE. The CDC has tracked the bacteria to health care facilities in 42 or more states compared with one case in a single state in 2001, he says.
Frieden is calling on all hospitals to take a "detect and protect" strategy to save lives and stop the bacteria's spread in hospitals, other medical facilities and potentially to healthy people in the community. The CDC recommends:
• determining if patients have CRE by receiving immediate alerts from the hospital's lab, asking the patient and, in some cases, screening them for the bacteria;
• grouping patients with CRE together;
• dedicating staff, rooms and equipment to the care of CRE patients when possible;
• having hospitals and medical facilities alert each other when patients with CRE are transferred;
• removing temporary devices like catheters as quickly as possible;
• using antibiotics wisely.
According to Frieden, half of all antibiotics prescribed in this country are either unnecessary or inappropriate and they increase drug-resistant infections such as CRE.
The good news is that instituting the CDC's recommendations works. "We have seen in outbreak after outbreak that when facilities and regions follow CDC's prevention guidelines, CRE can be controlled and even stopped," says Michael Bell, M.D., acting director of the CDC's division of health care quality promotion.