Fast Facts: CRE “superbug” cases soar in U.S. hospitals, what you should know

A recent study suggests that cases of the deadly “superbug” known as CRE increased five-fold in community hospitals from 2008 to 2012 in the Southeastern U.S. While the number of patients discovered was relatively low, at 305, study authors believe rates of infection are actually much higher and threaten health care facilities across the nation. We sat down with infectious disease specialist Cristie Columbus, MD, vice dean at the Texas A&M College of Medicine, to find out what hospitals can do to prevent further spread of the drug-resistant bacterium that is so serious, the Centers for Disease Control and Prevention labeled it a “nightmare bacteria.”

Q: What is CRE?
A: CRE (Carbapenem-Resistant Enterobacteriaceae) are a group of antibiotic-resistant bacteria that usually strike people in hospitals, nursing homes and other health-care settings. Because this group of bacteria is resistant to several classes of antibiotics, it’s commonly called a “superbug.” A 2013 Centers for Disease Control and Prevention (CDC) report estimated 9,300 people in the U.S. are infected by CRE every year, resulting in approximately 600 deaths. The increase we are currently seeing is concerning, given the average 50 percent mortality rate of these types of infections.

Q: How is CRE spread?
A: CRE is usually spread in the health-care setting from person-to-person through contact with infected or colonized people, particularly contact with wounds or stool. CRE can cause infections when they enter the body, often through medical devices like ventilators, intravenous catheters, bladder catheters, or wounds caused by injury or surgery.

Q: How are hospitals dealing with the superbugs?
A: Many hospitals have adopted new laboratory guidelines for improving detection of these types of microorganisms.  Once detected, appropriate infection control precautions should be implemented, including meticulous hand hygiene programs, disinfection practices, and proper isolation precautions to prevent transmission between patients. Communication between health-care facilities is key. Many hospitals are also encouraging discontinuation of medical devices as soon as they are no longer needed. Additionally, many hospitals have implemented antimicrobial stewardship programs to limit the use of broad spectrum antibiotics when appropriate.

Q: How bad is the situation?
A: The CRE situation is particularly concerning, because of the limited number of effective antibiotics currently available for treatment of infections with these organisms.

Q: Is the overuse of antibiotics to blame for the spread of such superbugs?
A: Excessive use of antibiotics, particularly those that have activity against a wide range of bacteria, can contribute to the development of resistance in many types of bacteria, including CRE.

Q: What, if anything, can we do about it?
A: CDC recommends that patients be sure to tell their doctors if they have been hospitalized in another facility or another country. Additionally CDC recommends that antibiotics be taken only as prescribed. Everyone should practice good hand washing or hand hygiene and expect their health care providers to do so as well.

Dr. Columbus has particular interest in health care epidemiology and infection control and prevention. A diplomate of the American Board of Internal Medicine and of the Subspecialty Board of Infectious Diseases, Dr. Columbus is also a member of several national professional organizations including the American Medical Association, the American College of Physicians, the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. She is also a member of the Texas Infectious Disease Society, Texas Club of Internists and active regionally in the Texas Medical Association, where she served on the Committee on Infectious Diseases.