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CRE incidence increased fivefold in southeastern US
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The rate of carbapenem-resistant Enterobacteriaceae cases in community hospitals in the southeastern United States has increased fivefold since 2008, according to a report in Infection Control and Hospital Epidemiology.
WHO has classified carbapenem-resistant Enterobacteriaceae (CRE) as “one of the three greatest threats to human health” and the CDC has deemed it “a serious threat to public health.”
“This dangerous bacteria is finding its way into health care facilities nationwide,” Joshua Thaden, MD, of the division of infectious diseases at Duke University, said in a press release. “Even this marked increase likely underestimates the true scope of the problem given variations in hospital surveillance practices. A CRE epidemic is fast approaching and we must take immediate and significant action in order to limit the transmission of these dangerous pathogens throughout our hospitals and acute care facilities.”
Joshua Thaden
Thaden and colleagues evaluated CRE surveillance data collected prospectively at 25 community hospitals throughout North Carolina, South Carolina, Virginia and Georgia from 2008 to 2012. During this time, 305 CRE isolates were detected at 16 of the hospitals. Symptomatic CRE infection was seen in 180 cases and asymptomatic colonization was found in the other 125 cases. The most prevalent species was Klebsiella pneumoniae (91%), and most cases (94%) were health care-associated.
The rate of detection in 2008 was 0.26 cases per 100,000 patient-days, which increased fivefold to 1.4 cases per 100,000 patient-days in 2012. The researchers found that only five hospitals had adopted the 2010 Clinical and Laboratory Standards Institute carbapenem breakpoints, and these hospitals were more likely to detect CRE after their implementation than before: 4.1 vs. 0.5 isolates per 100,000 patient-days. In addition, hospitals that implemented these breakpoints were more likely to detect CRE than hospitals that did not: 3.3 vs. 1.1 isolates per 100,000 patient-days.
“This is a wake-up call for community hospitals,” Thaden said. “More must be done to prepare and respond to CRE, specifically infection control to limit person-to-person transmission and improved laboratory detection.”
In an accompanying editorial, Christopher Pfeiffer, MD, of Oregon Health & Science University, said financial and staffing shortages were challenges to community hospitals in preventing CRE.
“CRE prevention and control could benefit from regional collaborative networks armed with knowledge and resources to assist individual facilities and coordinate between facilities, which have been successful in the control of other antibiotic-resistant bacteria,” he wrote.
For more information:
Pfeiffer C. Infect Control Hosp Epidemiol. 2014;35:984-986.
Thaden J. Infect Control Hosp Epidemiol. 2014;35:978-983.
Disclosure: Thaden and Pfeiffer report no relevant financial disclosures.