Dr. Don Donahue on Outbreak of ‘nightmare bacteria’ in Illinois

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From The Wall Street Journal –

The largest outbreak to date of one strain of what authorities have called “nightmare bacteria” is adding to concerns about the spread of such drug-resistant bugs.
The outbreak, centered on a hospital in a Chicago suburb, has infected 44 people in Illinois over the past year, the Centers for Disease Control and Prevention said. The bug, known as carbapenem-resistant enterobacteriaceae, bears a rare enzyme that breaks down antibiotics.
“This is a huge cluster,” said Alex Kallen, a medical officer with the CDC and supervisor for the Illinois outbreak investigation, noting that only 97 cases of the infection have been reported to the agency since 2009.
The superbug, which typically lives in the intestines and is part of a large family of bacteria, can be spread via fecal matter. It isn’t typically transmitted by casual contact outside hospitals.

Analysis by Dr. Don Donahue:

CREPreventionThe emergence of carbapenem-resistant enterobacteriaceae (CRE) offers another example of the consequences of over or misuse of antibiotics, the presence of antibiotics in the food chain, and the need for aggressive infection control measures in hospitals and long term care facilities.

Enterobacteriaceae are a normal part of the bacteria found in the human digestive tract, and include Klebsiella species and Escherichia coli (E. coli).  Strains of antibiotic-resistant, and specifically resistance to carbapenem antibiotics, have emerged over the past decade. 

While only 97 cases of this particular bacteria have been detected – almost half in Illinois over the past year – a 2013 CDC report noted that almost 200 hospitals and long-term acute care facilities in 42 states treated at least one patient infected with these bacteria during the first half of 2012.CREs produce enzymes such as KPC (Klebsiella pneumoniae carbapenemase) and NDM (New Delhi Metallo-beta-lactamase) that break down carbapenems and make them ineffective.

CRE infections are typically nosocomial, or hospital acquired.  CRE infections most commonly occur among patients who are receiving treatment for other conditions and whose care includes use of ventilators (breathing machines), urinary (bladder) catheters, or intravenous (vein) catheters.  Patients who are taking long courses of certain antibiotics are most at risk for CRE infections.

The growth of CREs is concerning because these infections are hard to treat and have a roughly 50 percent mortality rate, much higher than the more commonly known MRSA or Clostridium difficile.  A 2012 CDC recommendation to healthcare providers advised:
•    enforcing use of infection control precautions (standard and contact precautions)
•    grouping patients with CRE together
•    dedicating staff, rooms and equipment to the care of patients with CRE, whenever possible
•    having facilities alert each other when patients with CRE transfer back and forth
•    asking patients whether they have recently received care somewhere else (including another country)
•    using antibiotics wisely.

Increasing resistance to antibiotics is a serious matter.  The recent decision by the FDA to limit routine use of antibiotics in agriculture reflects this concern.  While government, agriculture, and medicine move to limit the spread of this danger, individuals can help protect themselves as well as contribute to countering the spread of antibiotic resistant bacteria: 

  • Use antibiotics only when appropriate, never for viral infections. 
  • Follow the prescribed regimen completely; never stop taking your medicine even if you feel better. 
  • Practice personal hygiene, frequent and proper hand washing. 
  • When hospitalized, advise your provider if you have received care elsewhere. 
  • Ensure that staff washes their hands when interacting with you as a patient, and especially when working with ventilators, catheters, or other invasive items. 

Awareness can be your best defense.

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