Blog | 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."