CDC warns of drug-resistant Enterobacteriaceae

This article has been reproduced entirely from the website below via the excellent Jo Tarrants Infection Update website.

This is a really interesting article and worth a read, article originated by Lisa Schnirring on the 5th March

http://www.cidrap.umn.edu/cidrap/content/other/resistance/news/mar0513resistant.html

CDC warns of drug-resistant Enterobacteriaceae Lisa Schnirring Staff WriterMar 5, 2013 (CIDRAP News) – Federal officials today warned of a new type of antibiotic-resistant threat that is more dangerous than methicillin-resistant Staphylococcus aureus (MRSA), but could be curbed now with prompt action from health leaders, healthcare workers, and even patients, they say.Carbapenem-resistant Enterobacteriaceae (CRE), seen primarily in patients who have been exposed to hospital settings, are "nightmare bacteria" that pose a triple threat, according to the US Centers for Disease Control and Prevention (CDC).CRE, which include two common digestive system organisms, Klebsiella pneumoniae and Escherichia coli, are resistant to nearly all antibiotics, have a high mortality in invasive infections, and can spread resistance genes to other bacteria in patients' bodies, CDC officials said.Tom Frieden, MD, MPH, the CDC's director, said in a briefing today, "It's not often that scientists come to me and say we need to sound an alarm. The good news is we have an opportunity to prevent further spread."CDC officials said they're basing their warnings on data from three surveillance systems, including one that showed the proportion of CRE among all Enterobacteriaceae increased from 1.2% in 2001 to 4.2% in 2011. Another showed an increase from 0% in 2001 to 1.4% in 2010. The agency published the findings today in a Vital Signs report in Morbidity and Mortality Weekly Report (MMWR).The CDC saw the percentage of CRE infections increase most for Klebsiella, which spiked from 1.6% in 2001 to 10.4% in 2011 in one database. "That's a very troubling increase," Frieden said.The CDC also found that almost 200 hospitals and acute-care long-term care facilities treated at least one patient infected with CRE from a catheter-associated urinary tract infection or a central-line–associated bloodstream infection.Risks appear to be highest in patients with complex medical problems or who are in long-term care settings, according to the agency. The rate of CRE-affected facilities varied from 3.9% among short-term-care facilities to 17.8% among long-term-care facilities.So far 42 states have reported at least one case, and as yet there's no sign that CRE has spread beyond patients who had extensive hospital exposure, Frieden said. "It's not as widespread as MRSA, and it's important we keep it that way," he said.He said, however, that CDC officials are encouraged by dramatic reductions in CRE rates in facilities that are using a toolkit the CDC released in 2012 aimed at preventing the infections."Doctors, hospital leaders, and public health must work together now to implement CDC’s 'detect and protect' strategy and stop these infections from spreading," Frieden said.Steps include identifying patients who have CRE infections through lab alerts, keeping healthcare teams informed when patients who have CRE infections are transferred in and out of facilities, observing contact precautions during care, setting aside special rooms to care for CRE patients, removing temporary devices such as catheters as soon as possible, and carefully monitoring antibiotic use.Frieden urged patients and their loved ones to insist that health workers wash their hands and to ask if catheters and intravenous lines can be removed as soon as possible. Two other approaches could include chlorhexidrine baths for patients and the development of advanced molecular detection systems, he added.Arjun Srinivasan, MD, associate director for healthcare-associated infection prevention programs at the CDC, said though active CRE surveillance is under way, its presence can vary by region, so there is no one-size-fits-all strategy. New York City, for example, has been battling CRE for several years, he said.The Vital Signs report said the percentage of hospitals reporting CRE was highest in the Northeast and among larger and teaching hospitals.Health departments can play a vital role in reducing the CRE threat by bringing health facilities together to keep providers informed about disease patterns and ways to detect and prevent the infections, Srinivasan said. "We're all in this together."Frieden said so far six states mandate reporting of CRE cases: Colorado, Minnesota, North Dakota, Oregon, Tennessee, and Wisconsin. Others are considering mandatory reporting.