Prevention Needed as CRE on the Rise in Hospitals, Long-Term Healthcare Facilities

As the superbugs known as carbapenem-resistant Enterobacteriaceae (CRE) have continued to spread over the last decade with cases in at least 42 states, the Society for Healthcare Epidemiology of America (SHEA) urges healthcare professionals, facilities, patients and stakeholders to work together in an effort to prevent the bacteria from becoming a widespread epidemic.

We cant afford to wait until a large-scale outbreak occurs to fight these dangerous bacteria, says Dr. Sara Cosgrove, who serves as a board member of SHEA. To effectively combat bugs like CRE, we need to confront the problem at hand that has allowed them to thrive the overuse of antibiotics in healthcare. We know that one-third of antibiotics prescribed to patients in hospitals are unnecessary. Excessive antibiotic use combined with failure of healthcare workers to wash hands before and after caring for patients allows these bugs to develop and spread and negatively impacts patients, hospitals, and our entire healthcare system.

CDCs Vital Signs report found that since some CRE is resistant to most available antibiotics, this makes the bacteria difficult to treat and can result in death in 50 percent of patients who become infected. Those most at risk include patients with complex medical issues or receive long-term care.

A new study featured in Infection Control and Hospital Epidemiology reports a significant increase in CRE bacteria found in healthcare settings like long-term care facilities and nursing homes. This trend suggests that patients are unknowingly transferring the bug between hospitals and long-term care facilities.

Drug-resistant infections are also associated with increased length of hospital stay, increase hospital costs, increase risk of getting a series outcome, and increased risk of death.  A study showed that giving a patient a carbapenem antibiotic can increase their risk of getting CRE by 15 fold.

The CDC and SHEA have released studies demonstrating that when CDC recommendations are implemented, CRE can be decreased by over 50 percent. Improving the use of antibiotics correlates with eliminating healthcare costs, as hospitals can save up to $400,000 per year. 

SHEA recommends key groups across the healthcare spectrum work together to successfully prevent CRE outbreaks. Recommendations include:
 Healthcare facilities to adopt CDC guidelines and implement programs to improve antibiotic use.
 Healthcare professionals and outpatient facility employees should ensure their teams are following contact precautions when the first CRE patient is identified and pay strict attention to hand hygiene and environmental cleaning.
 Patients should to speak up and insist that everyone who comes near you during your medical care doctors, nurses, technicians, even visitors washes their hands. Ask about specifics of medical care relating to catheters or other medical device, ask how long you will have it and request that it is removed as soon as possible.
 Local and state public health networks should carefully track CRE cases and devise regional strategies on how to document and share a patients history given the high transfer rates between hospitals and outpatient units.

Given the lack of new drugs to treat these infections, we must focus our efforts on preventing transmission of these pathogens. Through a coordinated effort, we can ensure the health and safety of patients by staving off the spread of antibiotic-resistant superbugs, save healthcare dollars, and most importantly, save lives, says Cosgrove.