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There’s more evidence that untreatable or tough-to-treat infections from a rare but deadly superbug are on the rise in U.S. hospitals, ratcheting up concerns about stopping the spread before it gets worse, health officials said Tuesday.
Last year, about 4 percent of U.S. acute-care hospitals and 18 percent of long-term acute care hospitals reported at least one case of dangerous CRE bacteria -- Carbapenem-resistant enterobacteriaceae -- germs resistant to most last-resort antibiotics.
That’s according to new figures released by the Centers for Disease Control and Prevention, which analyzed data from about 3,900 U.S. hospitals in the first six months of 2012.
"CRE are nightmare bacteria," CDC Director Dr. Tom Frieden told reporters.
Figures may show that CRE are still rare, but analysis from three different data pools revealed a big jump in the infections during the past decade. The percentage of certain bacteria reported to be resistant to carbapenem antibiotics -- often the drugs of last resort -- climbed from 1.2 percent in 2001 to 4.2 percent in 2011, a spike of about 250 percent.
“The message that we’re trying to send is there’s an opportunity here,” the CDC’s Dr. Arjun Srinivasan, associate director for healthcare-associated prevention programs said in an interview before Tuesday's press conference. “It’s an uncommon issue, but it’s concerning. There’s an opportunity to act while it’s still uncommon.”
CREs increased most for the worrisome Klebsiella pneumoniae, jumping from 1.6 percent to 10.4 percent between 2001 and 2011, a rise of 550 percent. That’s the bug that made headlines last summer after reports that it was part of an outbreak that swept through the National Institutes of Health Clinical Center near Washington, D.C., killing seven people, including a 16-year-old boy.
CDC relied on CRE data collected from the National Nosocomial Infection Surveillance System, or NNIS, and its successor, the National Healthcare Safety Network, or NHSN. More data came from another source called the Surveillance Network-USA, known as TSN.
CREs are part of a family of drug-resistant germs that have shown up in growing numbers of U.S. health care settings. They’re named for their ability to fight off carbapenem antibiotics, which have been the big gun drugs used to treat serious infections. CRE infections typically show up in people who’ve been hospitalized frequently, who have been taking antibiotics and who may require devices such as ventilators or catheters.
They often present as hard-to-treat bloodstream or urinary tract infections.
CRE infections tied to Klebsiella now have been detected in 42 U.S. states and Puerto Rico, the CDC reports. That's particularly worrisome because the mortality rate for CRE bloodstream infections can be as high as 50 percent and CRE infections can spread like wildfire through a hospital.
No one knows exactly how many cases there have been in the U.S. or how many deaths may be tied to CREs, Srinivasan said.
CDC has launched an all-out campaign -- a "detect and protect" strategy to urge hospitals and other health care facilities to be on guard for CREs. The agency issued a health alert last month warning that the number of unusual forms of CRE has nearly doubled since last July. That includes the notorious NDM bug -- New Delhi metallo-beta-lactamase -- which produces an enzyme that renders antibiotics virtually useless.
Health care providers should be alert for evidence of CRE in their facilities, CDC says, and act promptly to detect and contain the bug. Patients exposed to the germ should be kept together, away from others. Hospital staff should be vigilant about hand hygiene and exposing patients to potentially contaminated materials. Some states and some sites have better systems in place to catch CREs, including places such as Colorado and Florida, which have had outbreaks and grappled with the problem of stopping them.
“The actions right now are uneven,” Srinivasan said.
Patients worried about catching a CRE infection can take certain precautions, too, he suggested. Risk may be higher in people who are hospitalized frequently or who are transferred from one type of hospital to another. For instance, someone who suffers a stroke may be treated at an acute-care hospital, but then transferred for longer-term critical care at another site.
Patients or family members should ask about the risk of CRE, especially in people who require ventilators or catheters or those who show signs of infection, such as a fever. Check with the staff about the steps they take to prevent hospital-acquired infections, Srinivasan said.
“Ask: What are you doing to keep me safe from CRE?” he suggested.