March 10, 2013

Tackling the latest superbug threat

Unnecessary prescribing and taking of antibiotics lead to deadly, drug-resistant bugs like CRE.

By SARA COSGROVE and RAMANAN LAXMINARAYA McClatchy Newspapers

This past summer in Colorado, doctors had found a rare superbug had infiltrated their hospital after the bacteria was detected in eight patients.

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Over the last decade, the CDC has tracked the spread of the superbug known as CRE from a single health-care facility in North Carolina to facilities in at least 42 states.

Nearly 2,000 miles away, this superbug quickly spread through the National Institutes of Health Clinical Center, killing seven people.

The bug, known as carbapenem-resistant Enterobacteriaceae, or CRE, adapts quickly, is resistant to the most potent antibiotics, and preys on the most vulnerable populations in health-care facilities.

Because CRE are resistant to most available antibiotics, they are difficult to treat, and can lead to death for up to 50 percent of patients who become infected.

The Vital Signs report released recently by the Centers for Disease Control and Prevention reveals CRE are increasingly finding their way into intensive-care units and long-term health facilities in the United States.

Although the numbers of infections are likely still small, this looming public health threat is one that must be decisively addressed.

Over the last decade, CDC has tracked the spread of these bugs from a single health-care facility in North Carolina in 2001 to health-care facilities in at least 42 states.

A new study published in Infection Control and Hospital Epidemiology reports a significant increase in CRE bacteria found in health-care settings like long-term care facilities and nursing homes. This trend suggests that patients are unknowingly transferring the bug between hospitals and long-term-care facilities.

We have a small window of opportunity to control this serious threat, when it is potentially manageable.

Data from CDC suggest that in the first half of 2012, only about 200 hospitals and long-term acute-care hospitals have cared for patients with CRE infections, but the recent upward trend in infection rates is cause for concern.

To effectively combat superbugs like CRE, we need to confront the problem at hand that has allowed them to thrive: the overuse of antibiotics in health care.

Studies have shown that one-third of antibiotics prescribed to patients in hospitals are unnecessary.

The overuse of antibiotics breeds drug-resistant infections, which negatively affects patients, hospitals and our entire health-care system.

One study showed that simply giving a patient carbapenem (a strong antibiotic that can sometimes kill off healthy gut bacteria) increases the risk of contracting CRE by a factor of 15.

Improving the use of antibiotics in a hospital can actually save the hospital $400,000 or more per year. The entire health-care system benefits when we improve antibiotic use and decrease drug-resistance.

Health-care facilities must take a proactive approach to implement programs that improve antibiotic use.

Health-care professionals should take every precaution to prevent the spread of deadly infections, including simple tasks like hand washing.

Patients should feel empowered to question their doctors and nurses about whether an antibiotic prescription is necessary.

There has been much attention on the rising costs of health care. Here, we have an opportunity to invest in a proven approach that will provide rapid health benefits and cost savings to the American people.

Through a coordinated effort, we can ensure the health and safety of patients by staving off the spread of antibiotic-resistant superbugs like CRE, save health-care dollars, and most important, save lives.

Dr. Sara Cosgrove is an associate professor of medicine and epidemiology at Johns Hopkins University and serves on the board of the Society for Healthcare Epidemiology of America. Dr. Ramanan Laxminarayan is director and senior fellow at the Center for Disease Dynamics, Economics & Policy and lead investigator on the Extending the Cure Project.

 

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