“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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