CRE superbug outbreak: what is it and what can be done?

The UCLA (University of California, Los Angeles) was recently shaken by 179 infections and two deaths from a ‘superbug’ called the “Carbapenem-resistant enterobacteriaceae” or CRE for short.

Currently, according to news reports, an 18 year old man is battling for his life after being infected by the disease which is spread by contaminated health devices.

What is CRE and why is it so dangerous?

CRE is a family of drug-resistant bacteria that has evolved into “superbugs”. To summarise it shortly, these superbugs cannot be killed by bacteria. Once these superbugs enter someone’s bloodstream and infect them, it can cause death.

CRE is just one of the Health Care Associated Infections (HCAI). The others are:

1)    MRSA Methicillin resistant Staphyloccous aureus;

2)    VRE Vancomycin resistant Enterococci spp;

3) ESBL Extended-spectrum beta (β)-lactamase gram-negative organisms; and

4)    MRAB Multi-resistant Acinetobacter baumannii.

In 2014, the World Health Organisation (WHO) released the Anti-microbial Resistance Global Report on Surveillance 2014 which surveyed 114 countries.

“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” WHO’s Assistant Director-General for Health Security Dr Keiji Fukuda said.

How common are these superbugs?

The Centers for Disease Control and Prevention says: “Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.”

“There were an estimated 722,000 healthcare-associated infections in U.S acute care hospitals in 2011,” CDC says. About 75,000 hospital patients died from these infections.

How CRE happens

CRE happens through the dissemination of Klebsiella pneumoniae carbapenemase (KPC) producing bacteria which is highly drug-resistant and which can cause morbidity and mortality.

The first outbreak began in the northeaster United States, but now happens worldwide. It is a global problem since the first detection of these enzymes since the late 1990s.

Why does it happen?

CRE happens due to inappropriate use of antibiotics in general and use of broad spectrum antibiotics in particular. Furthermore, it is spread through the contaminated hands of health workers and contaminated health equipment which leads to outbreaks and serious infections, particularly in critically ill patients.

For example, in the recent cases in UCLA, specialised endoscope were at issue. These endoscopes are inserted down the throats of half a million patients to treat cases such as cancer and gallstones. However, these medical devices are difficult to disinfect because of their design.

The infections are raising questions whether hospitals are doing enough to protect their patients.

In 2012, Ronald Reagan UCLA Medical Center received an F grade by healthcare watchdog Leapfrog.

And last month, 11 of 32 patients infected with the CRE superbug in Virginia Mason Medical Center in Seattle were killed. However, the hospital defended themselves by stating that the patients were critically ill in the first place.

Has CRE spread to Asia?

Yes. In 2013, 26 cases were reported in Sibu Hospital, Malaysia. Two of the infected patients died.

But the spread of the ‘superbug’ in Asia is most alarming in India. Dr. Timothy R. Walsh, a professor of microbiology at Cardiff University told the New York Times that “India’s dreadful sanitation, uncontrolled use of antibiotics and overcrowding coupled with a complete lack of monitoring the problem has created a tsunami of antibiotic resistance that is reaching just about every country in the world.”

The solution so far:

There are not many drugs that can cure CRE, as Carbapenems are considered an antibiotic of the last resort. A range of antibiotics such as beta-lactams, penicillins, and cephalosporins are ineffective in killing the germs.

Therefore, hospitals are recommended to implement a standard precaution which involves strict hand hygiene. In fact, it has been demonstrated that strict hand hygiene have been successful in decreasing the rate of Multi-Drug Resistant Organisms (MDRO) which CRE is a part of. The implementation of hand hygiene must be multimodal and sustained over time.

Category: Health alert, Top Story