CDC urges increased prevention, surveillance of superbugs

By Anthony Brino
11:56 AM

The Centers for Disease Control and Prevention is asking hospitals and public health agencies to increase their efforts to track, isolate and hopefully slow the growth of an emerging variety of highly antibiotic-resistant bacteria.

First detected in one state in 2001 and now present in 42 states, carbapenem-resistant Enterobacteria (or CRE) has killed half of all patients whose bloodstream get infected with it, according to a report released by the CDC.

The agency found that CRE was present in about 4 percent of all U.S. hospitals and in about 18 percent of long-term acute care hospitals in the first six months of 2012. CRE are part of a 70 species family, including E. coli, and deaths from them are still relatively rare, the CDC says (without saying how many) — but they’re growing in antibiotic resistance.

The proportion of antibiotic-resistant Enterobacteria has grown from 1 percent to 4 percent in the past decade, with 10 percent of one species found to be resistant. Further, some of the bacteria are so amorphous they can transfer their resistant properties across species, which would be a huge problem for more common but less lethal bacterial infections such as E. coli.

As if hospitals weren’t under enough duress with health reform and the roughly 100,000 Americans thought to be already dying from hospital-acquired infections annually, the CDC says the rise of these so-called superbugs has the potential to either be nipped in the bud or create real havoc.

“Our strongest antibiotics don't work and patients are left with potentially untreatable infections," CDC director Tom Frieden, MD, said in a media release.

As CREs and other potentially dangerous bacteria have troubled both hospitals and long-term care facilities, the CDC says it’s important to boost surveillance and preventive sterility approaches during transitions of care between facilities, especially as hospitals increasingly rely on skilled nursing facilities for post acute care.

In addition to recommending clinical guidelines for keeping workers, devices, patients and settings sterile, the CDC is urging public health agencies to increase surveillance to understand local prevalence of at least several key species.

“Given the ability of state and local health departments to interface with different types of facilities, public health is in a unique position to coordinate the local and regional response,” the agency said.

Among other things, CDC epidemiologists hope to track the local origins of the bacteria and how they spread in the hospital, and to what extent the bacteria could be spreading to outside the hospital.

In 2011, CDC researcher Clifford McDonald and colleagues analyzed about 10,000 infections from another bacteria with growing antibiotic resistance, C. difficile, at 85 hospitals and found that infections originated within the hospital 50 percent of the time, from the surrounding community about 23 percent of the time and the rest somewhere in between.

A potential indication of how CREs may evolve or spread, British researchers traced several global waves of C. difficile over the past decade, with one more dangerous variety originating from around Pittsburgh in 2001 before spreading to South Korea and Switzerland, and another highly-resistant strain originating from around Montreal before spreading to the U.K. and Europe.

The CDC is encouraging more robust IT use and emphasizing the importance of information exchange between providers and labs, who should have protocols for “the rapid notification of appropriate clinical and infection prevention staff whenever CRE are identified from clinical specimens.”

Hospitals can also be increasing digital reporting of infectious disease and prevention measures via their EHRs, rather than completing online or telephone surveys.

Informaticists at the Regenstrief Institute, Indiana University, and Purdue University also suggest that hospital-based infection preventionists are underutilizing available IT tools, with only 20 percent participating in IT planning and few having access to data analytics software. That survey also found that nearly half of infection preventionists were unaware of their hospital’s participation in a health information exchange.