“Nightmare bacteria” resistant to the strongest antibiotics are on the rise in the United States and have infected patients in at least 17 Wisconsin hospitals and long-term rehabilitation facilities, state and federal officials said Tuesday, March 6.
The bacteria kill up to half of all infected patients.
“It’s not often that our scientists come to me to say that we have a very serious problem, and we need to sound an alarm,” said Tom Frieden, director of the federal Centers for Disease Control and Prevention. “But that’s exactly what we’re doing today.”
Within the past decade, the bacteria, called carbapenem-resistant Enterobacteriaceae or CRE, have become more drug-resistant, and their prevalence has increased more than fourfold, Frieden told reporters during a telebriefing.
Perhaps most worrisome: They can transfer their antibiotic resistance to other bacteria, including E. coli — the most common cause of urinary tract infections.
CRE bacteria enter the bloodstream primarily through central lines — tubes placed in a large vein in a patient’s neck, chest or arm — as well as through catheters and ventilators.
Nearly 200 hospitals and long-term acute care facilities around the country have encountered the superbug. The CDC tracked one type of CRE from a single health care facility to health care facilities in at least 42 states, including Wisconsin. In some medical facilities, the bacteria already pose a routine challenge, the CDC reported Tuesday.
“It seems to travel relatively easily,” said Nasia Safdar, an infectious disease specialist at University of Wisconsin Hospital and Clinics and an associate professor at UW School of Medicine and Public Health.
One risk is patients who move from institution to institution, such as from a nursing home to a hospital to a rehabilitation hospital.
In Wisconsin, 15 hospitals and two long-term acute care facilities have reported the bacteria, with 25 people infected, since Dec. 1, 2011, when the state began surveillance for CRE.
Five picked up the bacteria in a setting other than a hospital, according to the state Division of Public Health. How many people died from the infection is unknown.
Wisconsin is among the first six states to require facilities to report infections associated with the superbug, though the surveillance is still new and many hospitals and long-term acute care facilities may not be aware of it, said Gwen Borlaug, coordinator of the state program that monitors health care associated infections.
The state voluntarily decided to require reporting after the Wisconsin State Laboratory of Hygiene became aware that CRE was in Wisconsin, and lab officials wanted to begin doing genetic testing on the bacteria, Borlaug said.
“We wanted to know where they were to strategically place prevention measures,” she said. “We’re at a pretty low prevalence now, and we want to keep it that way.”
Frieden of the CDC said doctors, nurses, hospital leaders and the public health community must work together to implement a “detect and protect” strategy to stop these infections from spreading.
He referred to CRE as “nightmare bacteria.”
Milwaukee is one of four cities around the country piloting a regional collaboration for CRE surveillance and prevention through a contract with the National Association of County and City Health Officials.
The city was chosen for the surveillance pilot because it already has a strong network that links public health officials with all types of health care facilities.
The Milwaukee Health Department is developing a tool kit to educate health care providers and patients and to improve detection of CRE.
“Many of my colleagues are unfamiliar with CRE,” said Paul Biedrzycki, director of disease control and environmental health for the Milwaukee Health Department. “This is an emerging infection.”
In September, a workshop on the superbug will be held for hospitals, nursing homes, long-term acute care providers, emergency medical service personnel and others.
“We’re working to strengthen surveillance around CRE,” said Geoffrey Swain, chief medical officer and medical director for the Milwaukee Health Department.
The risk of CRE infection is highest among patients receiving complex or long-term care in hospitals, long-term acute care facilities and nursing homes.
Many hospitals have taken steps to reduce their infection rates in recent years, spurred partly by Medicare now requiring them to publicly disclose their infection rates and partly by Medicare no longer paying hospitals for additional care to treat hospital-acquired infections.
The steps range from stressing the importance of staff washing their hands, to requiring doctors to be fully gowned while inserting a central line, to removing catheters as soon as possible.
The number of central-line infections has fallen sharply as a result, according to a CDC report released earlier this month. Urinary tract infections from catheters also have fallen, though not as sharply.
At the same time, the improvements were not seen at all hospitals.
The two types of bacteria that worried hospitals and other facilities have been methicillin-resistant Staphylococcus aureus and C. difficile, commonly known as MRSA and C. diff.
Now they must add CRE to the list.
“We haven’t seen this infection yet, but we are gearing up for it,” said David Shapiro, chief medical officer of Columbia St. Mary’s Health System.
Health systems and hospitals typically take a series of steps when a patient has an antibiotic-resistant infection. These include isolating the patient, requiring anyone entering his or her room to be fully gowned and not using the patient’s equipment on other patients.
The hospitals in Wisconsin that have had CRE infections are not publicly disclosed.
Wisconsin is not among the few states that require hospitals to disclose to the public information on infection rates for specific types of bacteria, such as MRSA.
That has frustrated consumer advocates.
“If you are going into the hospital, you sure as heck would want to know that,” said Lisa McGiffert, director of the Safe Patient Project at Consumers Union, the publisher of Consumer Reports.
The Consumers Union began a campaign in 2003 to publicly disclose infection rates at hospitals.
An estimated 2 million people a year get infections in hospitals, McGiffert said, and almost 100,000 of them die.
“This report today is the future in hospital infections,” she said. “We have to get smarter than the bug. We have to take aggressive action.”
How to stay safe
What you can do to protect yourself and prevent the spread of drug-resistant bacteria:
— Speak up. Insist that everyone you interact with during medical care — doctors, nurses, technicians, visitors — wash their hands before and after touching you.
— If you have a catheter, an intravenous line or a urinary catheter, ask how long you’ll have it and request it be removed as soon as possible.
— If a doctor prescribes antibiotics for you, make sure they are necessary. And don’t pressure a doctor to prescribe one just because you have a fever. Half of all antibiotics prescribed are either unnecessary or inappropriate. Overuse and misuse of antibiotics increase drug-resistant infections, and many antibiotics have been shown to increase the risk of getting CRE.
–If you’re a health care provider, know if your patients have CRE and request immediate alerts from your laboratory every time they identify a patient with CRE.
— If you are a provider and your facility is either receiving or transferring a patient, make sure to find out if the patient has CRE.
— Whenever possible, health care facilities should have specific rooms, equipment and staff just for CRE patients to prevent the bacteria from spreading.