Musings

Musings

The first week of March 2013 brought us news and headlines like the following:

‘Nightmare’ Bacteria Spreading in U.S. Hospitals, Nursing Homes

TUESDAY, March 5 — A “nightmare” bacteria that is resistant to powerful antibiotics and kills half of those it infects has surfaced in nearly 200 U.S. hospitals and nursing homes, federal health officials reported Tuesday.

The U.S. Centers for Disease Control and Prevention said 4 percent of U.S. hospitals and 18 percent of nursing homes had treated at least one patient with the bacteria, called Carbapenem-Resistant Enterobacteriaceae (CRE), within the first six months of 2012.

The news article, originally written by Reuters senior Health & Science correspondent Sharon Begley, relied primarily upon a report published by the CDC in its Morbidity and Mortality Weekly Report (MMWR) titled, “Vital Signs: Carbapenem-Resistant Enterobacteriaceae“. Begley’s reporting was picked up by a number of news agencies and bloggers, was copied almost verbatim and then passed around all over the Web.

Lazy reporting notwithstanding, we are glad anytime something happens like this which helps to increase general awareness about the steadily growing threat of multi drug-resistant Superbugs. Not glad about the actual threat but glad to see anything that will help us to understand this situation is not going to go away and that we need to start thinking outside the box concerning how we’re going to deal with it as it continues to develop. Unfortunately, this is the really significant issue which the news reports failed to emphasize. [If you haven’t read it yet, be sure you take a look at the Bio/Tech News Special Report, “Superbugs: The Coming Global Pandemic“]

It’s certainly noteworthy that nearly 200 hospitals here in the U.S. have had to deal with one or more instances of Carbapenem-Resistant Enterobacteriaceae (CRE) during the first six months of 2012. And, it’s quite unsettling that nearly 20% of nursing homes treated someone with the bacteria. What’s more, it’s downright scary to think that CRE ends up killing almost 50% of those who become infected. [CRE are in a family of more than 70 bacteria called Enterobacteriaceae, including Klebsiella pneumoniae and E. coli, that normally live in the digestive system. The Enterobacteriaceae can spread rapidly in healthcare settings and are a common cause of community infection. See our Rogues Gallery for more information.]

All of this is disturbing, to say the least. But the real cause for alarm is that we no longer have anything in our existing arsenal of antibiotics which can effectively deal with some of these bugs. Until recently, the Carbapenems have been our big guns. Now, we’re starting to realize that we may have run out of bullets. The way it used to work was that a patient presented with a bacterial infection of some kind and the doc would routinely prescribe a round of antibiotics. And that was usually the end of the story. Besides, in the off-chance that didn’t do the job, there were always other, stronger antibiotics to try. That was the “old days”. Soon, doctors found themselves having to try other antibiotics and then eventually prescribe “cocktails” of more than one antibiotic in the hope of knocking out increasingly drug-resistant strains of pathogens. Of course, there were always the antibiotics of last resort, the really potent meds that were used when nothing else would work. Drugs like Vancomycin. And, the Carbapenems. But then, things changed. It wasn’t long before Vancomycin resistant strains started to appear. And now we’re beginning to see the same thing happening with a growing resistance to the Carbapenems. The bottom-line here is that, at present, we don’t have any other, stronger antibiotics available to us. And, it is highly unlikely that we’re going to have anything in the near future. This is “all she wrote”. This is the end of the line. At this point, the best way to deal with these new drug-resistant strains is to not get an infection in the first place. If you do, you’ve got a 50% chance you’ll survive.

So, what do the Centers for Disease Control and Prevention suggest we do? If you’ll read through the MMWR report we mentioned above, you’ll see that the best they can come up with is for hospitals to test patients upon admission to see if they are colonized or infected with any kind of drug-resistant Superbugs and then basically try to keep them away from other patients so that they can minimize the risk of spreading. Although this allows some measure of control at this early stage of development in CRE prevalence, there is no assurance CRE can be controlled over the long run without a way to actually kill the bacteria. The CDC appears to be whistling past the graveyard here.

At this point, CRE infections are most commonly occurring among patients who are in longer term healthcare settings (nursing homes, retirement centers, etc.), receiving ongoing treatment for other conditions. Patients whose care requires the use of devices like ventilators, urinary catheters, intravenous catheters, and patients who are taking long courses of certain antibiotics are most at risk for CRE infections. Longer-term patients make effective quarantine especially difficult, given the fact that many of them require multiple kinds of treatment and care which necessitates them being moved from location to location within and between healthcare facilities.

Once again, it’s important that we start thinking “outside the box”. Infection control is becoming a huge challenge and it’s only going to get worse. The CRE news item of early March has come and gone, but the threat continues. Please review the above-referenced BTN Report Superbugs: The Coming Global Pandemic to see some recommendations which we think are worthy of serious consideration for not only individuals and families but also for institutions like hospitals and long-term healthcare facilities…

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