Tuesday, March 12, 2013

The "Superbug" Problem: What Does the CDC's CRE Report Really Mean?

The Great Wave off Kanagawa (wikipedia,
Library of Congress)
Hi everyone! I am back after a long hiatus (vacation and lots of time on the medicine wards/ infectious disease consult service).

I was interviewed this morning by a local radio program about the "Superbug" problem and antibiotic resistance (you can find the interview here, if interested).

This interview was requested, in part, by the recent CDC report on carbapenem-resistant Enterobacteriaceae ("CRE"), and the media coverage that has followed the release of this disturbing report.

Enterobacteriaceae are a group of organisms that typically inhabit the gastrintestinal tract. They are a major problem, especially in hospitals, where they can cause urinary tract infections UTIs), bloodstream infections and wound infections.

CRE are extremely antibiotic resistant bacteria; in some cases these bacteria are resistant to all known antibiotics. Carbapenems are a class of antibiotics often reserved for the sickest, most unstable patients; unfortunately, for CRE, these agents do not work. Not surprisingly, CRE infections have been associated with very high mortality (upwards of 50%). In the case of many of these infections we truly are realizing the "post-antibiotic era," and a return to pre-20th century medicine.

The CDC report notes that during the first 6 months of 2012 nearly 5% of all hospitals reporting on healthcare-associated infections (in this case, UTIs and bloodstream infections) reported at least one CRE infection. When broken down by hospital type, a whopping 17.8% of long-term acute care hospitals reported one of these infections (almost 1 in 5 of all such facilities!). Overall, comparing data from 2001 and 2011, the percentage of Enterobacteriaeceae that were carbapenem-resistant (e.g, CRE) went from approximately 1% to 4%. Looking at one of these organisms in particular (Klebsiella) resistance went from 2 to 10%!

The reality in 2013 is that a person can be admitted to the hospital for a hip replacement, develop a UTI with CRE, and die from the UTI because there are no effective antibiotics to combat the infection. Unless we act now, and decisively, as a society/ global community, we truly are at risk of entering the post-antibiotic era.

In reading about this issue the CDC has some terrific information. For the best commentary I have seen I refer you to the posts over at Controversies in Hospital Infection Prevention.

Only time will tell whether we have the collective wisdom and will to preserve the antibiotics we have, develop new drugs and curb the emergence of antibiotic resistance. If the looming problem of pan-antibiotic resistant organisms is a tsunami, let us have the wisdom to heed the warning of the CDC's CRE report, and get to high ground. As it stands, I fear we will collectively be asleep in bed when the wave breaks.

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