This past week, Houston hospitals, along with every other major medical facility in the country, received notification from the CDC that CRE infections were on the rise in the United States. Carbapenem-resistant Enterobacteriaceae are bacteria which are resistant to Carbapenem, a strong antibiotic often used when other drugs do not work. As a result, there are very few options available to medical staff when it comes to treating these new super infections. While there have been isolated cases in the past, the sudden rise in infections being reported to the Center for Disease Control has become worrisome. According to the CDC, the mortality rate for CRE infections is around 50%.
The first cases of Carbapenem resistant bacteria in Texas occurred in 2009. This was in a Klebsiella species producing Klebsiella pneumonia carbapenemase (KPC). In the United States, E. coli and Klebsiella have been the bacteria most suspected of causing CRE infections but other Enterobacteriaceae can be culprits. In the past, the CRE cases were as a result of bacteria making KPC. This enzyme is responsible for the inability of the antibiotic to kill the organism. Recent cases have included a variety of new types of antibiotic destroying enzymes. Because these new strains are more common in other parts of the world, health departments are advising doctors to consider the potential of a multidrug-resistant bacterial infection if the patient has recently received medical care outside of the country.
It is imperative that diligence be used in identifying and treating the infections because according to a study recently published in the American Journal of Infection Control, it can take over a year for infected individuals to test negative for the microorganisms. This long term infection provides many opportunities for the bacteria to latch on to someone else. Another concern is the fact that number of incidents is actually misrepresented because it is currently not mandatory for CRE infections to be reported to the CDC.
Multidrug-resistant bacteria are not a new thing. Many people have heard of Methicillin-resistant Staphylococcus aureus (MRSA) or of Vancomycin-resistant Enterococcus (VRE). This is no different in that bacteria seem to always find a way to combat the drugs used to kill them. In response, it is up to the medical community and the general populace to do what they can to keep the infections under control with proper monitoring, treatment, and reporting.
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