CDC Calls for Action Now to Halt Spread of Deadly
CRE Bacteria in Hospitals, Nursing Homes
Antibiotic-resistant CRE bacteria kills up to half of
patients who get bloodstream infections from them – seniors at highest
risk due to frequent hospital visits, lack of endurance
15, 2013 – Senior citizens and the caregivers who watch over them need
to pay close attention to a new threat from a family of bacteria that
has become increasingly resistant to last-resort antibiotics during the
past decade, and more hospitalized patients are getting lethal
infections that, in some cases, are impossible to cure.
The findings, published today in the Centers for
Disease Control and Prevention’s
Vital Signs report, are a
call to action for the entire health care community to work urgently –
individually, regionally and nationally – to protect patients.
During just the first half of 2012, almost 200
hospitals and long-term acute care facilities treated at least one
patient infected with these bacteria.
The bacteria, Carbapenem-Resistant
kill up to half of patients who get bloodstream infections from them.
In addition to spreading among patients, often on
the hands of health care personnel, CRE bacteria can transfer their
resistance to other bacteria within their family. This type of spread
can create additional life-threatening infections for patients in
hospitals and potentially for otherwise healthy people.
Currently, almost all CRE infections occur in
people receiving significant medical care in hospitals, long-term acute
care facilities, or nursing homes.
Spread of E. coli ST131 already a pandemic but has
received little attention in the U.S. – ‘making development of
strategies to halt further emergence and spread of these strains a
public health priority’
“CRE are nightmare bacteria. Our strongest
antibiotics don’t work and patients are left with potentially
untreatable infections,” said CDC Director Tom Frieden, M.D., M.P.H.
“Doctors, hospital leaders, and public health, must work together now to
implement CDC’s “detect and protect” strategy and stop these infections
Enterobacteriaceae are a family of more than 70
bacteria including Klebsiella pneumoniae and E. coli that normally live
in the digestive system. Over time, some of these bacteria have become
resistant to a group of antibiotics known as carbapenems, often referred
to as last-resort antibiotics.
During the last decade,
CDC has tracked one type
of CRE from a single health care facility to health care facilities in
at least 42 states. In some medical facilities, these bacteria already
pose a routine challenge to health care professionals.
The Vital Signs report describes that although CRE
bacteria are not yet common nationally, the percentage of
Enterobacteriaceae that are CRE increased by fourfold in the past
decade. One type of CRE, a resistant form of Klebsiella pneumoniae, has
shown a sevenfold increase in the last decade. In the U.S.,
northeastern states report the most cases of CRE.
According to the report, during the first half of
2012, four percent of hospitals treated a patient with a CRE infection.
About 18 percent of long-term acute care facilities treated a patient
with a CRE infection during that time.
In 2012, CDC released a concise, practical
CRE prevention toolkit
with in-depth recommendations for hospitals, long-term acute care
facilities, nursing homes and health departments. Key recommendations
● enforcing use of infection control precautions
(standard and contact precautions)
● grouping patients with CRE together
● dedicating staff, rooms and equipment to the
care of patients with CRE, whenever possible
● having facilities alert each other when
patients with CRE transfer back and forth
● asking patients whether they have recently
received care somewhere else (including another country)
● using antibiotics wisely
In addition, CDC recommends screening patients in
certain scenarios to determine if they are carrying CRE. Because of the
way CRE can be carried by patients from one health care setting to
another, facilities are encouraged to work together regionally to
implement CRE prevention programs.
These core prevention measures are critical and can
significantly reduce the problem today and for the future. In addition,
continued investment into research and technology, such as a testing
approach called Advanced Molecular Detection (AMD), is critical to
further prevent and more quickly identify CRE.
In some parts of the world, CRE appear to be more
common, and evidence shows they can be controlled. Israel recently
employed a coordinated effort in its 27 hospitals and dropped CRE rates
by more than 70 percent. Several facilities and states in the U.S. have
also seen similar reductions.
“We have seen in outbreak after outbreak that when
facilities and regions follow CDC’s prevention guidelines, CRE can be
controlled and even stopped,” said Michael Bell, M.D., acting director
of CDC’s Division of Healthcare Quality Promotion. “As trusted health
care providers, it is our responsibility to prevent further spread of
these deadly bacteria.”
Vital Signs is a CDC
report that appears on the first Tuesday of the month as part of the CDC
Morbidity and Mortality Weekly
Report, or MMWR. The report provides the latest data and
information on key health indicators. These are cancer prevention,
obesity, tobacco use, motor vehicle passenger safety, prescription drug
overdose, HIV/AIDS, alcohol use, health care–associated infections,
cardiovascular health, teen pregnancy, food safety and viral hepatitis.
CDC works 24/7 saving
lives, protecting people from health threats, and saving money to have a
more secure nation. Whether these threats are chronic or acute, manmade
or natural, human error or deliberate attack, global or domestic, CDC is
the U.S. health protection agency.
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