‘Nightmare’ Bug

CDC Warns Of Bacteria

Posted: March 20, 2013

HARRISONBURG — The Centers for Disease Control and Prevention is warning health care providers about a rare but spreading “nightmare bacteria” in an effort to contain the deadly antibiotic-resistant germs.

Carbapenem-resistant enterobacteriaceae, or CRE, are a small part of the enterobacteriaceae bacteria family, which includes more than 70 varieties that live in the digestive system, including E. coli.

Carbapenems are often referred to as an antibiotic of last resort and are among the most powerful at combating infection, according to CDC.

CDC released findings earlier this month in its Vital Signs report that “are a call to action for the entire health care community to work diligently — individually, regionally and nationally — to protect patients.”

Dr. Dale Carroll of Rockingham Memorial Hospital said he first heard of CRE about eight years ago.

“A CRE bacteria that was really resistant to one of the big guns was concerning,” said Carroll, chief medical officer and vice president of clinical effectiveness for RMH. “Over the last six, eight years, five or six other mechanisms have appeared among this family of bacteria to become resistant.”

Carroll said that while RMH has seen instances of CRE, he could not provide a specific number of cases, except to say it’s “very rare here, but it’s not zero.”

The CDC notes in a press release that although CRE are uncommon, the percentage of the bacteria family that are resistant has increased fourfold in a decade.

They’ve also spread to most states, including Virginia, while most cases are in the Northeast.

“CRE are nightmare bacteria,” Dr. Tom Frieden, CDC director, said in the release. “Our strongest antibiotics don’t work and patients are left with potentially untreatable infections. Doctors, hospital leaders and public health [officials] must work together now to implement CDC’s ‘detect and protect’ strategy and stop these infections from spreading.”

Most CRE infections occur in hospitals, long-term acute care facilities and nursing homes.

CDC recommends health care providers take infection control precautions, putting infected patients together, dedicating staff and equipment to CRE-infected patients, communicating with other providers when patients are transferred, asking patients where they’ve been treated and using antibiotics wisely.

Carroll said the bacteria spread primarily by contact, so the good news is basic good hygiene is effective to keep infections in check.

RMH has protocols in place for dealing with infections, prompting staff to be “very compulsive in infection control, even more so than normal,” he said.

Using the term “nightmare bacteria” to describe CREs is over the top, Carroll said, explaining that they are often still treatable.

“It’s not a death-of-mankind bug,” he said.

Regardless, he said, it’s an important issue to bring awareness to.

“It’s been fairly flat, but increasing over the last 10 years,” he said. “CDC knows we can break this chain of transmission by basic interventions, so I think it’s appropriate to say it looks like the curve is going up.”

CRE have spread to the U.S. from other parts of the world, so doctors can inquire about hospitalizations outside the country as a potential screening tool, said Dr. David Trump, state epidemiologist and director of the Virginia Department of Health Office of Epidemiology.

Trump said the concern with CRE is not the current situation, but what could happen if precautions aren’t taken by health care providers to contain the bacteria.

“It’s not where we are now,” he said. “It’s what we want to avoid happening, and …  we can do things right now to minimize the risk that these drug-resistant bacteria get a solid foothold here in our hospitals or in the United States.”

Contact Jeremy Hunt at 574-6273 or jhunt@dnronline.com

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