Healthcare-associated infections (HAI) are no stranger to hospitals, nursing homes and even locker rooms around the US. In fact, According to the CDC, 2013, one in 20 patients will develop some form of a HAI. Over the past week, much media attention has been focused on the bacterial strain known as CRE (carbapenum-resistant enterobacteriaceae).
The term CRE is actually used for various forms of bacteria that are resistant to many of the current antibiotics used in the US. The problem is that many organisms with the ability to produce an enzyme known as KPC have shared their genes with other types of bacteria. It is this enzyme that actually makes the bacteria resistant to antibiotics that would normally kill the bacteria. This shared genetic ability to make enzyme KPC is very dangerous especially in hospitals and long term facilities. These types of CRE infections have a 50 percent mortality rate associated with them (CDC, 2013.)
The good news is that these organisms are not rampant in the US. The CDC states that 92 percent of these infections were due to extensive hospitalizations. The public health concern is that these CRE infections may become more prevalent and cross over to the general population such as MRSE (Methicillin Resistant Staph Aureas). New antibiotic therapies are not emerging quickly enough to meet the changing genetically adaptable bacterial organisms. Darwin was correct when he announced that the ability for a living organism to avoid extinction is through adaptation. Bacteria are a classic example of this Darwinian point.
The CDC has developed the CRE toolkit (http://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf), which is a guidance system to prevent, control and decrease the amount of known CRE infection. When this toolkit was implemented in Israel, it decreased the amount of infection rates of all Israeli hospitals by 70 percent. CRE bacteria were once thought to exist outside the US but it reminds us that our world is much more connected than we often acknowledge. Good hand washing techniques, well controlled and monitored antibiotic use are always excellent measures to follow against the spread of disease. As of this writing, CRE is a force that is being addresses in regional hospitals and long term facilities in the US. Let us hope that it does not follow the path of MRSA. Stay well.
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