Laura Ungar

@laura_ungar

Dr. Forest Arnold worries about the growing menace of CRE — a deadly superbug that preys on hospitalized patients and kills about half who get bloodstream infections.

"We haven't seen much here, but I'm sure it's coming," said Arnold, an epidemiologist at University of Louisville Hospital and an associate professor of infectious diseases at U of L.

A study in the August issue of the journal Infection Control and Hospital Epidemiology shows cases of the antibiotic-resistant superbug rose fivefold in community hospitals in the Southeastern United States from 2008 to 2012.

Although the study didn't look at hospitals in Kentucky or Indiana, researchers at Duke University Medical Center said the rates reflect a growing problem across the region and throughout the country.

"People need to be aware," Arnold said. "It will eventually get here." And because Kentucky has a comparatively unhealthy population, with many patients suffering from multiple illnesses, "we have a lot of vulnerable people."

CRE, short for carbapenem-resistant Enterobacteriaceae, are a family of bacteria that have, over time, become resistant to last-resort antibiotics called carbapenems. CRE-related illnesses vary by where the germ infects the body and range from gastrointestinal illness to pneumonia to bloodstream infections.

"CRE is very dangerous. It is almost totally resistent to antibiotics," said Dr. Kevin Kavanagh, an infection-control activist who leads the Somerset, Ky.-based watchdog group Health Watch USA.

Kavanagh said Kentucky has one of the nation's highest rates of antibiotic use — and some of the time, those antibiotics are not necessary. Experts say overuse of antibiotics is one of the main factors driving the emergence and spread of superbugs.

Neither Kentucky nor the federal government tracks individual cases of CRE, but officials at local hospitals told The Courier-Journal last year that they've seen a growing number.

University Hospital officials, for example, said they had a case early last year in which the patient died, and Norton Healthcare officials said they had three cases in the first three months of last year and 10 others between 2010 and 2013.

Officials said they do all they can to prevent and combat CRE — stressing measures such as hand-washing, room-cleaning and using antibiotics more wisely.

"We continue to do that. It's a constant effort at staying aware," said Donna Meador, project director for the Kentucky Hospital Engagement Network. "Any time there's a new multi-drug-resistant organism, everybody in health care needs to be on alert."

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Growing national problem

Nationally, the CDC issued warnings last year about CRE, saying the bacteria spread from one medical facility in 2001 to numerous facilities in 46 states in 2013. CDC Director Tom Frieden said, "Our strongest antibiotics don't work, and patients are left with potentially untreatable infections."

He has dubbed them "nightmare bacteria."

CRE are the worst in a growing sea of pernicious germs resistant to antibiotics that take hold in health care settings. According to the U.S. Centers for Disease Control and Prevention, one in 25 hospitalized patients has at least one health care-associated infection on any given day.

Two of the more common superbugs are C. difficile, which is rising steeply and is linked to about 14,000 American deaths each year, and MRSA, which has been a problem in hospitals for decades. Researchers point to a recent decrease in invasive MRSA infections but estimate there were still more than 80,000 in 2011. MRSA has spread beyond hospitals into communities.

Doctors say they hope to control CRE before it becomes as common as MRSA.

"We're trying to sound the alarm. This is a problem for all of us in health care," said Deverick J. Anderson, senior author of the Duke study and an associate professor of medicine at Duke. "These (bacteria) are just about as bad as it gets."

Anderson's research team identified 305 patients with CRE through the Duke Infection Control Outreach Network, a cluster of 25 community hospitals in North Carolina, South Carolina, Virginia and Georgia. In those hospitals, the rate of CRE detection rose from 0.26 cases per 100,000 patient-days in 2008 to 1.4 cases per 100,000 patient-days in 2012. Researchers said those rates were likely underestimates.

Anderson said rates have probably risen just as much nationally at small community hospitals, "which are the main type of hospitals in the U.S."

Several doctors said they believe the same is happening at all sorts of hospitals.

"So far, CRE are just in the health care setting," Kavanagh said. "If it continues to grow and escape into the community, it will be an even bigger problem," and the medicines doctors count on to cure bacterial infections will no longer work against them.

He said antibiotics should be used only when they are absolutely necessary, and hospitals must remain vigilant about ensuring health care workers wash their hands often, keep rooms and medical equipment clean, wear gowns and gloves when appropriate and separate infected patients from others.

If the emergence and spread of superbugs aren't prevented, "we'll be in a post-antibiotic era," Kavanagh said. "And the danger is not going to go away unless we change the course of how we do things."

Reach reporter Laura Ungar at (502)582-7190 or on Twitter @laura_ungar.

SUPERBUGS 101

Some of the superbugs creating problems in hospitals and long-term-care facilities:

• CRE — Carbapenem-resistant Enterobacteriaceae can cause hard-to-treat and untreatable infections. CRE germs are resistant to all or nearly all antibiotics. They are not common, but they kill half of patients who get bloodstream infections. Almost all infections occur in patients receiving serious medical care. The exact number of infections and deaths from CRE is unknown.

• MRSA — Methicillin-resistant Staphylococcus aureus is a staph infection that doesn't get better with first-line antibiotics. One study showed MRSA infections kill 18,000 Americans a year. A health care provider or visitors may have staph germs on their bodies that can spread to a patient. Serious staph infections are more common in people with a weakened immune system. MRSA infections can also occur in healthy people who have not recently been in the hospital, but most of these are on the skin.

• C. diff — Clostridium difficile causes diarrhea linked to 14,000 American deaths each year. Those most at risk are people, especially older adults, who take antibiotics and also get medical care. The bacteria are found in the feces, and people can become infected if they touch items contaminated with feces and then touch their mouth or mucous membranes. Health care workers can spread the bacteria to patients or contaminate surfaces through hand contact.

Source: U.S. Centers for Disease Control and Prevention, U.S. National Library of Medicine