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A research assistant carries a biohazard cooler past the Ronald Reagan UCLA Medical Center in Los Angeles, where two people have died and nearly 200 may have been exposed to a deadly antibiotic-resistant bacteria. (Photo: AP Photo/Damian Dovarganes)
Superbugs are back — not that they ever really went away. The antibiotic-resistant bacteria, carbapenem-resistant Enterobacteriaceae (CRE), killed two people at UCLA’s Ronald Reagan Medical Center and infected five others, UCLA officials confirmed in mid-February. And later that month, North Carolina health officials announced that two Charlotte-area residents had died from CRE in the past few months. Most recently, four people were found to have been infected with the superbug at Cedars-Sinai Medical Center in Los Angeles, with an additional 67 other people possibly exposed.
The cases at Ronald Reagan Medical Center and Cedars-Sinai have been linked with a contaminated medical scope; the scope has been under scrutiny over recent days due to the revelation that the FDA never approved the manufacturer, Olympus, to sell the device.
The news has reignited a national concern about antibiotic-resistant bacteria in hospitals and has sparked the Centers for Disease Control and Prevention (CDC) to draft new guidelines for sanitizing medical devices.
CRE includes a family of bacteria that are difficult to treat because they have a high level of resistance to antibiotics, says Carrie Kojima, MPH. Kojima serves as manager of infection prevention at Hoag Orthopedic Institute in southern California, which has one of the lowest infection rates in the country.
The most common type of CRE is called Klebsiella pneumoniae carbapenemase, or KPC, says epidemiologist and infection control researcher Rosie D. Lyles, MD, MPH, head of clinical affairs for Clorox Healthcare.
“KPC and CRE bacteria are resistant to most antibiotics including carbapenems, one of the strongest antibiotics available, making infections with these bacteria very difficult to treat,” Lyles tells Yahoo Health. “That is why CRE prevention needs to be a top priority for healthcare facilities.” CRE can cause bloodstream infections, urinary tract infections, pneumonia, and other infections, she explains.
A three-dimensional illustration of the group of bacteria known as carbapenem-resistant Enterobacteriaceae (CRE), which has been implicated in four deaths in California and North Carolina. (Illustration: AP Photo/Melissa Brower/Centers for Disease Control and Prevention)
The CRE bacteria contain a gene that inactivates the carbapenems group of antibiotics, says Rebecca Horvat, PhD, director of molecular pathology at The University of Kansas Hospital and professor of pathology at University of Kansas School of Medicine.
There are several ways that CRE can spread and infect patients. The UCLA outbreak has been linked to contaminated endoscopes — specialized tubes with cameras at the end used to examine internal organs. But CRE can also be passed along via unwashed hands or wheelchairs, beds, and tables that weren’t fully disinfected, Horvat tells Yahoo Health. Infected medical devices, such as catheters or breathing machines, can also transmit CRE, Kojima adds.
Overall, hospital-related infections have decreased in recent years, research shows. A government report that included data from more than 14,500 hospitals and healthcare facilities showed significant national-level reductions in all health care-associated infections. From 2008 to 2013, for example, there was a 19 percent decrease in select surgical site infections.
But slower progress has been made on bacterial infections; there was an 8 percent decrease in hospital-associated methicillin-resistant Staphylococcus aureus (MRSA) from 2011 to 2013, and a 10 percent decrease in hospital-onset Clostridium difficile (C. diff) infections over the same time period.
“It’s important to remember that hospital-association infections are adverse events that are largely preventable, and in recent years, hospitals around the country have made real progress reducing infection rates,” Lyles says.
CRE, on the other hand, remains at “historically high levels,” Kojima says. CRE infections have been reported in 42 states over the past 10 years, according to the CDC, and may contribute to death in about half of infected patients.
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According to a 2014 study in the New England Journal of Medicine, some patients and facilities are especially at risk for hospital-associated infections. Infants, critical care patients, and large hospitals have an elevated risk, the study found.
The study also found that 4 percent of the 11,282 patients studied had developed at least one health care-associated infection. Lyles adds that prolonged intensive care stays, long courses of broad-spectrum antibiotics, and admission to long-term care facilities also increase a patient’s risks.
The Ronald Reagan UCLA Medical Center, where approximately 200 people were exposed to the antibiotic-resistant bacteria CRE. Officials have linked the outbreak to medical scopes that were not completely sanitized. (Photo: AP Photo/Damian Dovarganes)
“The majority of patients who are hospitalized do not acquire a health care-associated infection,” Horvat reassures. “The best way to prevent infection while at the hospital is to ask all visitors and health care workers to clean their hands when they enter the hospital room.” In addition, ask that all of the surfaces in your room be cleaned daily to reduce the number of microbes, Horvat says.
You’ll also want to tell your doctor if you’ve been hospitalized in another facility or country, and inform him or her about any recent medications or antibiotic use.
Keep in mind that CRE and MRSA aren’t the only bugs known to cause healthcare-associated infections. Other notable concerns include:
Acinetobacter baumannii, a pathogen that can quickly develop resistance to multiple drugs. It can infect the skin, central nervous system, bones, and other sites of the body, and cause pneumonia or blood infections, Lyles cautions. People who are critically ill, on catheters or ventilators, or have weakened immune systems are especially at risk, she adds.
C. diff — a bacteria that can cause life-threatening intestinal disease. It can be hard to control since it can live on surfaces for months at a time, Lyles says. “Those most at risk are people, especially older adults, who take antibiotics and also get medical care,” Kojima says.
Vancomycin-resistant enterococci (VRE), Horvat says, is another notable bacteria that can cause infection and has become resistant to the antibiotic most commonly used to treat it (vancomycin). Other antibiotics can be used to clear VRE infections, the CDC says.
To help prevent the spread of infections, both patients and health care facilities must take an active role, experts say. “Health care facilities should focus on a horizontal approach to infection control, which includes hand hygiene, thorough daily environmental cleaning and disinfecting, the use of contact precautions when necessary, staff education and ongoing training, and the prudent use of antibiotics,” Lyles says.
Lyles adds, “It’s also important to empower patients as active participants in infection prevention.” Translation: Even though it might feel odd asking your doc to wash his or her hands, speak up.