In last week’s blog I discussed “superbugs”, a term given to bacteria that
evolve to become resistant to some of the most commonly-used antibiotics. Drug resistant bacteria are a growing concern among healthcare professionals and the causes are partially related to overuse of antibiotics in our environment.
Today, I’d like to focus on one specific “superbug”, Carbapenem-Resistant Enterobacteriaceae, or CRE for short. It’s a deadly organism that resists treatment and is on the rise worldwide.
Enterobacteriaceae are microbes from a family of bacteria causing such common ailments as respiratory, intestinal and urinary tract infections.
Carbapenem is an antibiotic that has been used in the United States since 1985. 
Bacterial resistance occurs when specific bacteria evolve to develop an enzyme that makes them resistant to carbapenem. Such resistant infections are labeled as CRE.
CRE is difficult, and at times impossible, to treat since carbapenem is often the drug of last resort for certain bacterial infections, including e-coli and some pneumonia varieties.
Bacterial resistance to carbapenem was uncommon until about ten years ago.
Since then, there has been a four-fold increase in resistance to treatment. When resistance occurs, there are simply no other antibiotics effective against these infections, and the mortality rate for CRE has been reported as high as 50%.
The Centers for Disease Control and Prevention (the CDC) estimated that almost 92% of CRE occurs during hospitalization. That makes healthcare institutions the primary focus for prevention.
In 2012, the CDC developed a CRE Tool Kit for healthcare professionals and institutions to provide guidelines for prevention. The top four facility-level prevention strategies included hand hygiene (alcohol-based hand rubs), patient contact precautions, education of personnel and the proper use of devices associated with CRE (such as, venous and urinary catheters).
When a New York area hospital implemented the CDC’s CRE guidelines, that hospital reduced the occurrence of CRE by 50%. The country of Israel implemented similar guidelines in all of its 27 hospitals and reduced the incidence of CRE by 70% in one year.
CRE is on the rise! The CDC states that it is spread by improper hand sanitization, casual contact with affected patients, and the indiscriminant use of
medical devices. The spread takes on regional significance when affected patients receive care in several different healthcare settings—such as, transitioning from a hospital to a short-term or long-term care facility. In this way, the affected patient contaminates several facilities with the same antibiotic-resistant infection.
The simple solution is for healthcare institutions to follow the CDC’s guidelines for hand and device hygiene and to implement proper patient contact precautions. Although CRE will not be eradicated until new, more effective antibiotics are available, the incidence of CRE would be greatly reduced.
Thoughts? Comments? I’d love to hear them!
Prescription For Murder 
Jim,
Won’t this lead to a a new batch of CRE bacteria that are also resistant to alcohol? Check out “Relatively Alcohol-Resistant Mycobacteria Are Emerging Pathogens in Patients Receiving Acupuncture Treatment” at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC140401/. This article from “The Journal of Clinical Microbiology” mentions strains that show prolonged survival in 75% alcohol solution.
Walt.
Thanks, Walt, for sending us the link on alcohol-resistant bacteria. Those pesky bacteria keep evolving and cutting medical science off at the pass every time we try something different. BUT, what do you do – not try? The answer is to continue to introduce new antibacterials. Come on, Big Pharma, step up your game!
Thank you Jim for the information in this blog and the others you have written.
I appreciate you kind words, Robert.
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Thanks, Thomas for the repost on your blog site ! Hope your new book “The Clearing” is doing well. I just bought another copy – this time for my wife. Readers, take a moment to go to Amazon.com and order “the Clearing by Thomas Rydder.
My Moma always told me to avoid doctors and hospitals as much as I could, because that’s where sick people were. She was right, again!
Yes, hard as it may be to realize, but hospitals can be life savers as well as life threatening.
Thanks for this. I had missed this one. I don’t see much hope for improvement when bosses hassle those who don’t come in to work sick & infectious instead of sending those who do home so whatever is going around goes around more and gets stronger and stronger. In spite of the vaccine, I got the flu this year because I was foolishly researching in a university library (in the South) that has to be ground zero for diseases as they simply never send them home. Some even have brought in obviously highly infectious infants late at night. Someone with full blown flu (or whatever the bug was) came in and sat by me for about 15 minutes and I was done for for almost a week. I hope it is better in other parts of the country than mine but I suspect not.
Oops, forgot to add that the worst employer (sanitation wise and health wise) that I EVER had was a hospital. OMG, they hadn’t heard of GERM THEORY. Literally. And that was the nurse in Health Information Management over the ER people. Yes, I called her on it. She thought no matter what you had you should come in after a day or two.
I worked in an office area but when someone had pinkeye the woman they sent to clean up didn’t know what she was doing and someone in the office took over the assignment.
Jim,
The data you have presented is so ‘today’s’ problem. It is not dealing with an old drug like Penicillin (1928) or Sulfa (1934). Carbapenem (1985) and today we are dealing with CRE. The relevance of the blog is that the bacteria or at least the Enterbacteriaceae are winning just as the bugs of MRSA (Methcillin Resistant Staph Aureus) are winning.
Our big problems of the nation and the world may not be socioeconomic or immigration, but
resistant organisms and the antibiotics to deal with them. Thanks for the blog. jb
You are so right, Jim — our greatest challenges might just come in the way of an organic attack from our environment. Most don’t realize the significance of MRSA and CRE until it touches a loved one, but it is a growing and potentially catastrophic concern. Thanks for commenting.
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