News Column

Fighting a Super Bug

Jan. 2, 2013

Imagine if a strain of bacteria mutated quickly, swapping genetic material that provided immunity to the most potent medical weapons. Now imagine if we didn't know how to identify precisely that strain or track its spread.

You'd have an idea of the threat Carbapenem-Resistant Enterobacteriaceae poses for the patients in America's hospitals and nursing homes.

Such so-called "superbugs" are familiar by now. MRSA - methicillin-resistant Staphylococcus aureus - depending on the specific strain, can wreak havoc in the bodies of even healthy people.

CRE is different. And worse. The death rate from a CRE infection hovers around 40 percent.

"The bacteria ... are named for their ability to fight off carbapenem antibiotics - the last line of defense in the medical toolbox," USA Today reported in November. "And so far, they've emerged almost exclusively in health care facilities, picking off the weakest of patients."

The newspaper uncovered a medical system inadequate to tracking the bug, which is found in at least 41 states and endemic in major cities and in many states.

Virginia has early experience with an outbreak. Four years ago, USA Today reported, multiple CRE infections were diagnosed at the University of Virginia Medical Center. Within eight months, seven patients had died.

Even with the medical expertise U.Va. could deploy, the outbreak was a monster.

"When the doctors began analyzing the bacteria in their first patient, who'd transferred from a hospital in Pennsylvania, they found not one, but two different strains of CRE bacteria," USA Today reported. "And as more patients turned up sick, lab tests showed that some carried yet another."

That was the clue: The bacteria were acquiring new immunity even as doctors tried to fight it. But rapid mutation isn't the only barrier to fighting CRE, though it does make developing a drug difficult and unprofitable.

The Centers for Disease Control and Prevention advises traditional protocols for preventing CRE infection, including hand- washing, isolation and gowns and gloves for everybody. Such techniques have helped stem the spread of superbugs in some facilities. Hospitals and other health care centers also need better ways to screen for the germ.

Still, CRE is everywhere. It is constantly being re-introduced, even in hospitals where it has been controlled. One hospital system in the Bronx found 11 nursing homes - which rarely have the means to test for CRE - that regularly sent infected patients to the hospital.

But knowing such information, the newspaper reported, is the exception rather than the rule. There's no federal reporting requirement, so a national picture is difficult to decipher. Anecdotes and local reporting show that CRE is widely distributed and deadly.

Given CRE's potential for disruption - and death - a national way to track the disease should be the emergency first step.

Source: (C) 2013 The Virginian-Pilot and The Ledger-Star, Norfolk, VA. via ProQuest Information and Learning Company; All Rights Reserved

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