May 122013
Killer Carbapenem-Resistant Bacteria Spreading Across U.S.

Gut-living bacteria like Klebsiella are gaining resistance to carbapenems at an alarming rate, and long-term acute care hospitals (LTACs) and nursing homes seem to be the incubators for these killer bugs spreading across the U.S.

Carbapenems  like meropenem and doripenem have been the gold standard to treat infections from drug-resistant gram-negative gut bacteria, but these "big gun" antibiotics are increasingly ineffective. The first carbapenem-resistant Klebsiella pneumoniae was reported in a North Carolina long-term care facility only 10 years ago. Last year, nearly 1 in 5 long-term care facilities reported one or more carbapenem-resistant infections to the US Centers for Disease Control and Prevention (CDC).

The patients are often weak and vulnerable, and the organisms unstoppable: about half of the patients with these infections have died. Health care facilities in the Northeast are most affected, with a prevalence of carbapenem-resistant Klebsiella about 9 times that of the American West.

Carbapenem-resistant Enterobacteriaceae can transmit drug-resistant genes to ordinary drug sensitive in a module called a plasmid. This simple fact of bacterial evolution makes further spread of carbapenem resistance all but inevitable: 42 states have reported at least one case. However, this evolving epidemic can at least be slowed, public health officials believe.

The CDC issued guidelines on how hospitals can prevent the spread of carbapenem-resistant Enterobacteriaceae in 2012. Some of the highlights included (these bullet points are from the associated JAMA article):

  • Test patients for CRE and request immediate alerts from the laboratory when a case is found.
  • Inform other facilities when transferring a patient infected with CRE, and ask about such infections in incoming patients.
  • Use contact precautions to prevent the spread of CRE.
  • Allocate specific rooms, equipment, and staff for the treatment of patients with CRE.
  • Remove catheters and other devices as soon as possible.
  • Prescribe antibiotics carefully.

CDC Director Thomas Frieden, MD, MPH, called carbapenem-resistant Enterobacteriaceae  "nightmare bacteria" at a press briefing in March 2013, telling reporters, “We only have a limited opportunity to stop these bacteria from spreading to the community." Are these drug-resistant bacteria creating nightmares in your neighborhood LTAC?

Morbidity and Mortality Weekly Report (MMWR): Vital Signs: Carbapenem-Resistant Enterobacteriaceae.

Bridget M. Kuehn, MSJ. “Nightmare” Bacteria on the Rise in US Hospitals, Long-term Care Facilities. JAMA. 2013;309(15):1573-1574.

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Killer carbapenem-resistant bacteria spreading through LTACs