Carbapenem-Resistant Enterobacteriaceae Pose Triple Threat

Carbapenem-resistant Enterobacteriaceae (CRE) are an increasing and deadly threat in healthcare facilities in the United States of America.

Enterobacteriaceae are a large family of gram-negative bacilli that normally live in the human gastrointestinal tract, and are a common cause of both community- and healthcare-acquired infections.

The US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) has now issued an early warning, while the resistant infection is so far limited to inpatient facilities. Although resistance to broad-spectrum antibiotics has been seen for several decades, resistance to the carbapenem antimicrobial class is recent and appears to be spreading. During the first six months of 2012, among the 3,918 US acute-care hospitals performing surveillance for either catheter-associated urinary tract infections (CAUTI) or central-line-associated bloodstream infections (CLABSI) in any part of their hospital, 181 (4.6%) reported one or more infections with CRE, 145 in short-stay hospitals and 36 in long-term acute-care hospitals.

During the 5-month Emerging Infections Program (EIP) project pilots, 72 CRE were identified from 64 patients; 56 patients had 1 positive culture; 8 had 2. Fifty-nine came from the Atlanta metropolitan area, with 10 in the Minneapolis-St. Paul area and 3 from Portland, Oregon. There were 49 CRE identified as Klebsiella species, 14 as Enterobacter species and nine were Escherichia coli. The most common source was urine at 89%, with 10% in blood samples.

Thomas Frieden, MD, MPH, the CDC director, called CRE "nightmare bacteria" that post a "triple threat," because the organisms are resistant to nearly all antibiotics, they kill up to half of those infected, and they are capable of spreading their resistance to other bacteria. He advised that hospitals, nursing homes, and long-term care institutions adopt the recommendations issued previously in a CRE prevention toolkit.

Hospitals that have adopted the toolkit's recommendations have seen dramatic reductions in CRE infections. It advises measures such as requesting information about CRE-infected patients from laboratories; enforcing standard infection control and contact precautions; grouping CRE-infection inpatients together, using dedicated staff and equipment if possible; and prudent antimicrobial use. The report was published on March 8, 2013, in the journal Morbidity and Mortality Weekly Report.

Related Links:
US Centers for Disease Control and Prevention