The Centers for Disease Control (CDC) published the March 2013 edition of Vital Signs on March 5. Featured was the news about carbapenem-resistant Enterobacteriaceae (CRE), a group of antibiotic resistant bacteria being discovered causing infections in the U.S. The Examiner spoke to Ghinwa K. Dumyati, M.D., Associate Professor - Department of Medicine, Infectious Diseases, University of Rochester Medical Center about the topic on March 15.
Dr. Dumyati is an expert on infections acquired in healthcare settings and she has published papers on nosocomial infections and on antibiotic resistant bacterial infections. The doctor was quick to point out two details from the CDC effort; the number of patients infected by CRE is small and most of those patients were seriously ill to begin with. One of the antibiotics of last resort in seriously ill patients is carbapenem, given via IV.
Dumyati said the the public "should not be alarmed." These infections are "very uncommon." The major concern for the public health community is the potential that these bacterial infections could move from the hospital into the general community. The number of CRE infections can only be estimated because, as the doctor states, they are not tracked and reported to state or federal public health authorities by all localities.
Enterobacteriaceae form a family of over 70 species of bacteria, the CDC states. They live in the human digestive system. Many of the bacterial species are key to the digestion and absorption of nutrients from food.
Dr. Dumyati has seen other bacteria become resistant to antibiotic treatment. The CRE, however, are challenging because they have developed several mechanisms for resistance. In addition, CRE bacteria are sharing the genes for resistance with other bacterial species from the Enterobacteriaceae family, creating new CRE variations within those species.
Patients with CRE infections, Dumyati states, are those with multiple medical conditions and usually have some sort of physical intervention being performed on their bodies. Catheters, central lines and intubation are common in these patients and are believed to be the mechanism for entry of CRE bacteria into the body outside of the digestive system.
Dr. Dumyati offers several suggestions for patients and their families. She reminds everyone that "you can ask the doctor to wash his hands." Hand washing is vital and all healthcare workers should be washing before performing any procedures such as changing catheters.
Both physicians and patients need to be alert to the correct use of antibiotics. The doctor stressed the importance of testing for the disease causing bacteria so that the correct antibiotic and dosage can be prescribed. Resistance to antibiotics is caused by overuse, incorrect use and by patients who do not take the prescribed medication as directed.