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Cases of Drug-Resistant ‘Superbug’ Increase Significantly in Southeastern U.S.

Carbapenem-resistant Enterobacteriaceae is on the rise

Cases of infection with highly contagious carbapenem-resistant Enterobacteriaceae (CRE) have increased fivefold in community hospitals in the Southeastern United States, according to a study published in the August issue of Infection Control and Hospital Epidemiology.

“This dangerous bacterium is finding its way into health care facilities nationwide. Even this marked increase likely underestimates the true scope of the problem, given variations in hospital surveillance practices,” said lead author Joshua Thaden, MD. “A CRE epidemic is fast approaching. We must take immediate and significant action in order to limit the transmission of these dangerous pathogens throughout our hospitals and acute-care facilities.”

CRE organisms are not susceptible to most commonly used antibiotics. Labeled “one of the three greatest threats to human health” by the World Health Organization, these dangerous pathogens can cause infections in the urinary tract, lungs, blood, and other areas. Patients with CRE infections have a high risk of mortality, with at least 48% of cases proving fatal.

Over a 5-year study period, researchers identified 305 patients with CRE through the Duke Infection Control Outreach Network — a group of 25 community hospitals in the Southeastern U.S.

In this retrospective cohort, infection-prevention professionals identified cases via prospective surveillance using standardized protocols in all hospitals. However, most microbiology laboratories in the study had not adopted the most recent, and more sensitive, guidelines for detecting the bacteria. In hospitals that had adopted the guidelines, the rate of CRE detection was more than three times higher.

More than half (59%) of the patients with CRE were symptomatic, and nearly all cases were associated with health care (60% community-onset, health care-associated; and 34% hospital-onset). The higher rate of infection was found to stem from a combination of factors, including:

  • Increased use of broad-spectrum antibiotics
  • Ease with which CRE enzymes could be transmitted among bacteria
  • Increased transmission between long-term acute-care facilities and community hospitals

“This is a wake-up call for community hospitals,” Thaden said. “More must be done to prepare for and respond to CRE, specifically infection control to limit person-to-person transmission and improved laboratory detection.”

Source: SHEA; July 16, 2014.

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