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Deadly 'superbugs' invade U.S. health care facilities
A new family of antibiotic-resistant bacteria, known as CRE, is raising concerns across the medical community because of its ability to cause infections that defy even the strongest antibiotics. The antibiotic resistance is spread by mobile pieces of DNA that can move between different species of bacteria, creating new, drug-defying bugs.
Antibiotics and resistant bacteria.
Resistant bacteria dominate.
The resistance gene.
Pili bridge.
Resistance gene transfer.
A USA TODAY review finds that deadly CRE bacteria are showing up in hospitals and other health care facilities across the country and there is virtually nothing to stop these "superbugs" at this point.
12:34PM EST November 29. 2012
CHARLOTTESVILLE, Va. - The doctors tried one antibiotic after another, racing to stop the infection as it tore through the man's body, but nothing worked.
In a matter of days after the middle-aged patient arrived at University of Virginia Medical Center, the stubborn bacteria in his blood had fought off even what doctors consider "drugs of last resort."
"It was very alarming; it was the first time we'd seen that kind of resistance," says Amy Mathers, one of the hospital's infectious-disease specialists. "We didn't know what to offer the patient."
The man died three months later, but the bacteria wasn't done. In the months that followed, it struck again and again in the same hospital, in various forms, as doctors raced to decipher the secret to its spread.
The superbug that hit UVA four years ago -- and remains a threat -- belongs to a once-obscure family of drug-resistant bacteria that has stalked U.S. hospitals and nursing homes for over a decade. Now, it's attacking in hundreds of those institutions, a USA TODAY examination shows, and it's a fight the medical community is not well positioned to win.
The bacteria, known as Carbapenem-Resistant Enterobacteriaceae, or CRE, are named for their ability to fight off carbapenem antibiotics -- the last line of defense in the medical toolbox. And so far, they've emerged almost exclusively in health care facilities, picking off the weakest of patients.
The bacteria made headlines this summer after a CRE strain of Klebsiella pneumoniae battered the National Institutes of Health Clinical Center outside Washington, D.C. Seven died, including a 16-year-old boy. (Hospitals don't reveal victims' names in keeping with medical privacy rules.) But that case was neither the first nor the worst of the CRE attacks.
USA TODAY's research shows there have been thousands of CRE cases throughout the country in recent years -- they show up as everything from pneumonia to intestinal and urinary tract infections. Yet even larger outbreaks like the UVA episode, in which seven patients also died, have received little or no national attention until now.
The bacteria's ability to defeat even the most potent antibiotics has conjured fears of illnesses that can't be stopped. Death rates among patients with CRE infections can be about 40%, far worse than other, better-known health care infections such as MRSA or C-Diff, which have plagued hospitals and nursing homes for decades. And there are growing concerns that CRE could make its way beyond health facilities and into the general community.
"From the perspective of drug-resistant organisms, (CRE) is the most serious threat, the most serious challenge we face to patient safety," says Arjun Srinivasan, associate director for prevention of health care-associated infections at the Centers for Disease Control and Prevention.
Since the first known case, at a North Carolina hospital, was reported in 2001, CREs have spread to at least 41 other states, according to the CDC. And many cases still go unrecognized, because it can be tough to do the proper laboratory analysis, particularly at smaller hospitals or nursing homes.
To assess the threat and what's being done to stop it, USA TODAY interviewed dozens of health care authorities and reviewed hundreds of pages of journal articles, clinical reports, and state and federal health care data. The examination shows:
• CRE infections already are endemic in several major U.S. population centers, including New York, Los Angeles and Chicago, which account for hundreds of confirmed cases. Smaller pockets of cases have been reported across much of the country, including Oregon, Wisconsin, Minnesota, Pennsylvania, Maryland, Virginia and South Carolina.
• There is no reliable national data on the scope of the CRE problem. The CDC has urged states to track cases, but only a handful do so -- and they're just getting going. "We don't have enough … data to tell what the trend looks like," says Stephen Ostroff, director of epidemiology at the Pennsylvania Department of Health. "All we know is that it is here."
• There is little chance that an effective drug to kill CRE bacteria will be produced in the coming years. Manufacturers have no new antibiotics in development that show promise, according to federal officials and industry experts, and there's little financial incentive because the bacteria adapt quickly to resist new drugs.
• Many hospitals -- and an even greater percentage of nursing homes -- lack the capacity, such as lab capability, to identify CRE, or the resources to effectively screen and isolate patients carrying the bacteria. And even when screening is possible, there's a lack of consensus on whom to target.
"We're working with state health departments to try to figure out how big a problem this is," says the CDC's Srinivasan, noting that his agency can pool whatever incidence data states collect. "We're still at a point where we can stop this thing. You can never eradicate CRE, but we can prevent the spread. ... It's a matter of summoning the will."
Other experts are less optimistic.
"My concern is that there aren't a lot of methods in our tool kit that are significantly effective in curbing the spread of these infections," says Eli Perencevich, a professor and infectious-disease doctor at the University of Iowa's Carver College of Medicine.
The spread of CRE threatens to change the face of health care, crippling hospital units that specialize in treatments such as organ transplants and chemotherapy, which rely on the ability to control infections in patients with weak immune systems.
If unchecked, "these (bacteria) are going to greatly impact the kind of surgeries (and) treatments we can have," Perencevich says. "We're entering the post-antibiotic era; that's a very big problem."
Deadly 'superbugs' invade U.S. health care facilities
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