Two new studies out this week highlight the growing danger of antibiotic-resistant bacteria to global health.
The most alarming finding was that one type of dangerous bacteria could be spreading more rapidly—and mutating faster—than previously recognized, according to a study published in the Proceedings of the National Academy of Sciences on Jan. 16.
The bacteria in question is called "carbapenem-resistant Enterobacteriaceae," or CRE for short, and can cause serious infections throughout the body, including in the lungs, bladder, bloodstream, and skin.
The infections, which mostly occur in medical facilities, are often hard to treat—or are even untreatable—because the bacteria are resistant to many antibiotics.
Just last week, the Centers for Disease Control and Prevention reported that a Nevada woman in her 70s had died after being infected with a "nightmare bacteria" (a type of CRE) resistant to all antibiotics.
Then yesterday, the New England Journal of Medicine published findings from research conducted in South Africa showing that a strain of tuberculosis immune to most antibiotics spreads more easily than previously thought. That's concerning because the antibiotic-resistant form of tuberculosis—which is rare in the U.S.—though deadly, was not previously considered highly contagious.
Although the deadly strain of tuberculosis has not yet made it to the U.S., the spread of the disease in South Africa is an important reminder that we need to take precautions to contain CRE now, before it too mutates to become more contagious.
Most people who become infected with CRE encounter the bug in hospitals or long-term-care facilities, says Lisa McGiffert, director of Consumer Reports’ Safe Patient Project.
“Our healthcare facilities are our first—and possibly our only—line of defense,” says McGiffert. “This research underscores how critically important it is for them to take concrete steps now to contain these deadly superbugs before they spread more widely.”
Choose a Cleaner Hospital
There are several steps you can take during a hospital stay to help prevent infections from CRE and other disease-causing germs. A Consumer Reports' investigation reveals that some hospitals do a much better job than others at meeting the best practice standards necessary to stop the spread of bacteria and prevent infection.
The first step is to choose a facility that is scrupulous about cleanliness and infection control and that has an “antibiotic stewardship” program to make sure that these drugs are used appropriately, says McGiffert.
“Overuse of antibiotics is a common problem in hospitals and an important contributor to the rise of antibiotic-resistant bacteria such as CRE,” she says. (You can check our ratings to see how hospitals in your community compare in their ability to prevent infections.)
Tell your doctor whether you’ve been treated in a hospital or other healthcare facility in the last few years. If it was in an area where CRE bacteria are known to be more prevalent, or where there’s been an outbreak of infections, your doctor should do a simple test (an anal swab) to check to see whether you are a carrier of CRE bacteria.
If it turns out that you are a CRE carrier, the hospital staff should take special precautions to protect you from developing an active infection and to prevent the bacteria from spreading to other patients, says Maroya Walters, Ph.D., an epidemiologist with the CDC’s Division for Healthcare Quality Promotion. That includes putting you in a private room, she says, and always using gowns and gloves when treating you.
Protect Yourself in the Hospital
During your hospital stay, take the following steps to help prevent infection from CRE or other bacteria:
Insist on cleanliness. Ask to have your room cleaned if it looks dirty. Bring bleach wipes for bed rails, doorknobs, and the TV remote. Insist that everyone who enters your room wash his or her hands. Keep your own hands clean, washing regularly with soap and water.
Question antibiotics. Make sure that any antibiotics prescribed to you in the hospital are needed and appropriate for your infection.
Watch out for heartburn drugs. Medications such as the proton pump inhibitors Nexium or Prilosec increase the risk of a common and sometimes deadly infection from the bacteria Clostridium difficile (C. diff) by reducing stomach acid that normally helps keep the bug in check. So ask whether the drug is needed and, if so, request the lowest dose for the shortest possible time.
Ask every day whether catheters, ventilators, or other tubes can be removed. The risk of infection increases the longer they are left in place.
Say no to razors. If you need to be shaved, use an electric hair remover, not a razor, because any nick can provide an opening for infection.
Once home, you should be alert for signs of a possible infection. If you develop flu-like symptoms such as fever and chills, diarrhea, worsening pain, or areas of swelling, redness, or soreness, contact your healthcare provider right away.
CRE: An Incredibly Tricky Bug
Perhaps most worrisome is evidence from the PNAS study that CRE bacteria can pass from person to person undetected. “It seems that some people can carry the bug without getting sick, and spread it to others they come in contact with,” says William Hanage, Ph.D., associate professor of epidemiology at the Harvard T.H. Chan School of Public Health and senior author on the study.
That means, he says, that CRE bacteria may not be confined to outbreaks of infections in hospitals but are likely to be far more widespread in the community than once thought.
For the study, researchers from Harvard University, MIT, and other institutions tested patients at four hospitals—three in the Boston area and one in California—over a period of 16 months.
Their findings paint a more complete picture of a superbug that is “incredibly diverse and tricky,” Hanage says.
“[CRE bacteria] have more ways of fending off antibiotics than we had suspected,” he says. “And the genetic material that holds the key to that resistance can be easily transferred to other bugs so that they become antibiotic-resistant, too.”
Those “tricks” were what allowed the type of bacteria that killed the woman in Nevada to become invincible.
Keeping a Rare Bug From Spreading
Currently, CRE infections are relatively uncommon. This antibiotic-resistant bacteria is responsible for 9,300 infections and 600 deaths each year in the U.S., according to the CDC. Most of those people infected by it were vulnerable because they were already sick or had a compromised immune system, says the CDC's Walters.
It's also important to note that the virulent strain of CRE that is immune to all antibiotics is exceedingly rare.
“In a way, it’s hopeful news that there have only been a handful of cases of CRE resistant to everything we’ve got, because that means that there's still time to keep it from becoming a more common problem,” says Walters. “But it also serves as a tragic reminder of what the future can bring if we don't contain this now.”
Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).
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