CDC Alert and Tips Aim to Slow the Spread of Deadly “Nightmare” Antibotic Resistant Bacteria known as CRE

In an alert posted on its web site, the CDC warned of a “lethal bacteria that pose a triple threat” to the public. The bacteria, Carbapenem-Resistant Enterobacteriaceae (CRE), are resistant to all, or nearly all, the antibiotics we have – even our most powerful drugs of last-resort. Also, CRE can kill up to half of patients who get bloodstream infections from them. Finally, and perhaps of greatest concern is that CRE bacteria easily transfer their antibiotic resistance to other bacteria.

In one example of the concern for the spread of one type of CRE, carbapenem-resistant klebsiella can spread its drug-destroying weapons to a normal E. coli bacteria, which makes the E.coli resistant to antibiotics also. That could create a nightmare scenario since E. coli is the most common cause of urinary tract infections in healthy people.

“CRE are nightmare bacteria. Our strongest antibiotics don’t work and patients are left with potentially untreatable infections,” said CDC Director Tom Frieden, M.D., M.P.H. “Doctors, hospital leaders, and public health, must work together now to implement CDC’s “detect and protect” strategy and stop these infections from spreading.”

The CDC has called on the entire health care community to work “urgently – individually, regionally and nationally – to protect patients.” According to the agency, an estimated 200 hospitals and medical centers treated at least one patient infected with the CRE bacteria in the first six months of 2012.

What is Carbapenem-Resistant Enterobacteriaceae (CRE)? According to the CDC, the CRE bacteria are a family of more than 70 bacteria including Klebsiella pneumoniae and E. coli that normally live in the digestive system. The problem is that over the years these bacteria have become resistant to a group of antibiotics known as carbapenems, often referred to as last-resort antibiotics. Researchers are working hard to try to stay ahead of the resistance by developing new antibiotics before the bacteria develop a resistance to everything.

In addition to the fact that the CRE bacteria can kill up to half of patients who get bloodstream infections from them, the CDC report also voiced concern that the bacteria can transfer their resistance to other bacteria within their family by spreading on the hands of health care personnel. The CDC warns that this type of spread can create additional life-threatening infections for patients in hospitals and potentially for otherwise healthy people. Currently, almost all CRE infections occur in people receiving significant medical care in hospitals, long-term acute care facilities, or nursing homes.

To help combat the spread of the CRE bacteria and infections, last year the CDC released a CRE prevention toolkit with in-depth recommendations for hospitals, long-term acute care facilities, nursing homes and health departments. Among the key recommendations from the CDC are:

– enforcing use of infection control precautions (standard and contact precautions)
– grouping patients with CRE together
– dedicating staff, rooms and equipment to the care of patients with CRE, whenever possible
– having facilities alert each other when patients with CRE transfer back and forth
– sking patients whether they have recently received care somewhere else (including another country)
– using antibiotics wisely

In addition, CDC recommends screening patients in certain scenarios to determine if they are carrying CRE. Because of the way CRE can be carried by patients from one health care setting to another, facilities are encouraged to work together regionally to implement CRE prevention programs.

“We have seen in outbreak after outbreak that when facilities and regions follow CDC’s prevention guidelines, CRE can be controlled and even stopped,” said Michael Bell, M.D., acting director of CDC’s Division of Healthcare Quality Promotion. “As trusted health care providers, it is our responsibility to prevent further spread of these deadly bacteria.”