by Kimberly Allen, RN
According to the Centers for Disease Control, health care facilities in 42 states are reporting an increase in the incidence of infection from a deadly bacteria – the bacteria known as a carbapenem-resistant Enterobacteriaceae or CRE. The CDC reports that incidence of CRE infections has increased from 1.2% of virulent infections a decade ago to 4.2% as of 2011. Now with the outbreak in the US, that figure stands to go up.
Enterobacteriaceae are a group of gram negative bacteria including E-coli and Klebsiella to name a few. Normally enterobacteriaceae are what is called “normal flora” that live in our digestive tract. However, if it gets out of the digestive tract it can cause some serious problems. Carbapenems are a group of antibiotics known as B-lactam antibiotics. They have a wide range of antibacterial ability and are considered “last resort” antibiotics. These have typically been used to treat infections by E-coli and Klebsiella pnuemoniae. However, recently experts have discovered a gene mutation in the enzyme that causes bacteria to be resistant to a wide variety of B-lactam antibiotics including those in the family of carbapenem family. This gene called NDM-1 was first discovered in Klebsiella pneumoniae. Since that time the incidence of resistant Klebsiella infections has increased from 1.6% of all resistant infections to 10.4% which has many health officials very worried. Tom Frieden, director of the CDC is calling the CRE bacteria a “nightmare bacteria”. Not only are the strongest antibiotics unable to effectively treat CRE, the situation is made worse because CRE are able to share the drug resistant gene with other normal microorganisms like E-coli making them resistant as well.
CRE has the ability to infect many systems of our body from the bloodstream to soft tissues and organs like those in the urinary tract. The CDC reports as many as half of the people that develop CRE infections in the bloodstream do not survive their infections. Most CRE infections occur in people that are in hospitals both long-term and acute care. These people are already compromised by some other serious illness requiring extended stays in either hospitals or nursing homes for complicated treatments. Most extended stays in either hospitals or nursing homes for complicated treatments. Most have a catheter, some are on ventilators while other have a variety of tubes and/or medical devices like IV’s that are used to decrease infection. The problem is these tubes are placed in sterile areas leaving a direct route from outside the body to a sterile area. These patients are also expose to many different staff members through but not only their day but for their entire stay.
Last year the CDC issued recommendations for health care providers to limit and/or prevent CRE infections. In addition to meticulous hand washing they recommend limiting the use of catheters, endotracheal tubes and other such devices that are normally used to decrease infection. They also recommend limiting the number of staff that care for and have contact with patients that have CRE infections.
Though the infection has not spread out into the community from medical care facilities many experts are seriously concerned that it could. cRE is not as wide spread as MRSA but many feel it is more serious. While MRSA can still be treated with antibiotics CRE infections are resistant to all antibiotics currently available. And what really worries experts is that there are no new antibiotics already being developed which means there’s not going to be anything anytime soon. This leaves doctors with an untreatable infection that can spread to the community at large infecting people that are otherwise healthy, especially if E-coli also becomes resistant to antibiotics.