Thursday, March 7, 2013
QD: News Every Day--Emerging superbug prompts warning to hospitals
Nearly one in 20 hospitals reported at least one health-care-acquired infection of carbapenem-resistant Enterobacteriaceae (CRE) last year, leading the Centers for Disease Control and prevention to issue a warning call for hospitals to use more of the existing preventive measures to control the spread of this rare but often deadly strain.
Last year, 4.6% of acute-care hospitals reported at least one CRE infection (short-stay hospitals, 3.9%; long-term acute-care hospitals, 17.8%). The proportion of Enterobacteriaceae that were CRE increased from 1.2% in 2001 to 4.2% in 2011 in one surveillance system and from 0% in 2001 to 1.4% in 2010 in another, with most of the increase seen in Klebsiella species (from 1.6% to 10.4% in one surveillance system).
The report appeared March 5 in MMWR.
During the first 6 months of 2012, among the nearly 4,000 U.S. acute-care hospitals performing surveillance for either catheter-associated urinary tract infections or central-line-associated bloodstream infections, 181 (4.6%) reported one or more infections with CRE (145 [3.9%] in short-stay hospitals and 36 [17.8%] in long-term acute-care hospitals.
"Data from population-based surveillance suggest most CRE clinical isolates came from cultures collected outside of hospitals from patients with substantial health-care exposures," the researchers wrote. "These findings suggest that although CRE are increasing in prevalence, their distribution is limited."
Invasive infections with CRE, such as bloodstream infections, are associated with mortality rates exceeding 40%, which is significantly higher than mortality rates observed for carbapenem-susceptible Enterobacteriaceae.
Among the successful efforts to control CREs are using active case detection and interventions such as segregating CRE patients and the staff who care for them.
"The high proportion of [long-term acute-care hospitals] LTACHs with CRE in 2012 highlights the need to expand prevention outside of short-stay acute-care hospitals into settings that, historically, have had less developed infection prevention programs," the researchers wrote.
Eli Perencevich, MD, ACP Member, offered his reaction online. Dr. Perencevich, an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in hospitals (including novel ways to get everyone to wash their hands), said in a tweet, "When federal officials tell us that washing our hands will prevent CRE or MRSA, they are washing their hands of the problem." He continued, "There have been only 4 high-quality studies of interventions to improve hand hygiene since 1980."
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
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Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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