Thursday, November 29, 2012

Superbugs are invading U.S. healthcare facilities

“Superbugs” are popping up more frequently in hospitals these days, even lasting through drugs of “last resort.” One of these superbugs made headlines this summer after it swept through the National Institute of Health just outside of Washington, DC. NAHAM News reported the story (found here) about staff having to go as far as to rip out plumbing from the walls to stop the spread of bacteria.

These superbugs belong to a string of drug-resistant bacteria known as Carbapenem-Resistant Enterobacteriaceae, or CRE, that has been around in hospitals and nursing homes for almost a decade.

A study by USA Today found that there have been thousands of cases of CRE throughout the country in recent years, affecting 41 states and several cities since the first case was reported in 2001. CRE is not as well-known as other hospital infections such as MRSA or C-Diff, but it is far more deadly. Even worse, there is little chance that an effective treatment for CRE will be developed any time soon.

A challenge for hospitals could be the reporting. There is no Medicare or Medicaid billing code for CRE, and there no reporting requirement so it is impossible to track the superbugs.

The Centers for Disease Control (CDC) has stated that the best way of controlling the spread of CRE may be the old fashioned way. They suggest “rigorous hand cleaning by staff and visitors; isolating infected patients and requiring gowns and gloves for anyone contacting them; cutting antibiotic use to slow the development of resistant bacteria; and limiting use of invasive medical devices, such as catheters, that give bacteria a path into the body.”

In one specific outbreak, a patient was discovered to have two different strains of the CRE bacteria, while other infected patients had a different third strain. All of the patients were linked together, showing that the drug resistant gene could jump between different bacteria, creating new bugs.

In the wake of that news, an important prevention measure because screening patients so that infected individuals can be isolated. However, this poses a challenge to hospitals that may not have the time or resources to screen all of their patients.

Despite the challenges, screening has been proven to work. One Bronx-based medical center started an initiative to cut prevalence rates across its intensive care units.  The initiative tested all intensive-care patients using an experimental, high-speed assay for the bacteria, and carriers were isolated immediately. The initiative eventually grew to all patients in the hospital network. The program controlled the transmission of CRE, but it also found that 40% of infected patients came into the hospital with the superbug already active.

The positive out of all this is that doctors were able to figure out how the drug resistant gene is jumping from strain to strain of the bacteria. Using that as a base, they were able to develop a test that would identify a superbug in days, as opposed to the weeks it was taking before. While this doesn’t help those who are already infected with CRE, it can help stop the spread to new patients.

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