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Still Chance to Stop Carbapenem-Resistant Enterobacteriaceae, CDC Says

Cheryl A. Thompson

BETHESDA, MD 05 Mar 2013—Carbapenem-resistant Enterobacteriaceae infections are on the rise, can kill, but are still controllable if hospitals and other health care facilities act now, the head of the federal Centers for Disease Control (CDC) stated today.

"There is now a critical window of opportunity to control [these] lethal bacteria," CDC Director Tom Frieden declared during a media briefing.

"And that window is open but not for long."

Arjun Srinivasan, associate director for CDC's health-care-associated infection prevention programs, said the agency has "some good evidence" that carbapenem-resistant Enterobacteriaceae are not yet present in the community.

Carbapenem-resistant Enterobacteriaceae are gram-negative bacilli, such as Escherichia coli, that resist the bactericidal activity of doripenem, imipenem, or meropenem.

About 4% of short-stay acute care hospitals and 18% of long-term acute care hospitals reported at least one case of carbapenem-resistant Enterobacteriaceae infection in the first half of 2012, according to surveillance results (PDF)External Link released today by CDC.

The data came from the 3918 acute care hospitals that report information about central-line-associated bloodstream infections or catheter-associated urinary tract infections to the National Healthcare Safety Network surveillance system.

"We've tracked CRE from a single health care facility in one state in 2001 to health care facilities now in 42 states or more," Frieden said. "In some of those places, these bacteria are now a routine challenge for patients and clinicians."

Health care leaders, clinicians, and health departments need to act now to prevent carbapenem-resistant Enterobacteriaceae infections from spreading to the community, he said.

Facilities that have implemented the tools in CDC's Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE): 2012 CRE Toolkit (PDF)External Link , Frieden said, "have seen dramatic reductions in their CRE rates."

Health care providers, he said, can take six important steps, all of which are described in the toolkit.

  1. Know if patients have a carbapenem-resistant Enterobacteriaceae infection and ask the laboratory to provide an immediate alert when such an infection is detected.
  2. Ask if newly transferred patients have a carbapenem-resistant Enterobacteriaceae infection.
  3. Follow contact precautions whenever treating a patient with a carbapenem-resistant Enterobacteriaceae infection.
  4. Whenever possible, assign specific rooms, equipment, and personnel to the care of patients with carbapenem-resistant Enterobacteriaceae infection.
  5. Remove temporary medical devices, such as catheters, from patients as soon as possible.
  6. Prescribe antimicrobials carefully.

"Many antibiotics have been shown to increase the risk of getting CRE," Friedan said. "For example, in one study, just giving a patient one of the antibiotics, a carbapenem, increased their risk of getting CRE 15-fold."

"On the flip side," he added, "individual hospitals have saved hundreds of thousands of dollars a year by improving antibiotic use; and, of course, patients benefit when they get targeted treatment" rather than a broad-spectrum agent.

 

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