Superbugs are the three horsemen of the post-antibiotic apocalypse, and they do the most harm where people go to get well—hospitals.
Superbugs lurk in the crevices of devices that made surgeries and diagnostic procedures safer and less invasive. For now, the worst superbug, Carbapenem-Resistant Enterobacteriaceae (CRE), is confined to hospitals and other medical facilities. If it escaped into the community, we would be a step closer to a post-antibiotic world.
Recently, at the UCLA Medical Center in Westwood, CA, seven patients were infected and two were killed by a deadly bacterial outbreak of CRE, also known as a “superbug,” stated Congressman Ted W. Lieu (D-CA-33). The hospital is in his district. He wants Congress to hold a hearing about sterilization failures that led to patients becoming infected during medical procedures. To Lieu, and to President Barack Obama, superbugs are a threat to national security.
“Addressing the problems posed by duodenoscope-linked superbug outbreaks is one step forward in combating the health and national security threats posed by antibiotic-resistant bacteria,” wrote Congressman Lieu. “I call upon the Committee on Oversight and Government Reform to fully investigate these life and death issues.”
About half the people who are infected with CRE die from it, according to the Centers for Disease Control and Prevention.
“CRE is the nightmare bacteria,” said Dr. Barbara Reynolds of the CDC. “If it moves from the hospital into the community,” we are in trouble. That’s because Carbapenem is the antibiotic of last resort. That’s the one CRE resists.
MRSA (Methicillin-resistant Staphylococcus aureus) is another contagious and antibiotic-
CRE would be harder to control if it escaped into the community, because it is so much more resistant than MRSA. It is nearly impossible to treat.
To prevent CRE from expanding its reach, hospitals must change the way they handle and clean duodenoscopes. The devices allow surgeons to look into a patient’s digestive system and to perform procedures via a flexible tube.
But it has become clear that current practices of sterilizing the devices do not work well enough to eliminate superbugs like CRE. The FDA issued an advisory saying so. Health care professionals can reduce the risk of hospital acquired infections for patients by cleaning medical devices differently and following checklists, according to Dr. Michael Bell of the CDC.
Each hospital infection that is prevented reduces the chance of a superbug becoming established outside of hospitals. Each person who does not get it does not pass it on to his friends, relatives, and caregivers.
The superbugs cause a lot of suffering. “Clostridium difficile was responsible for almost half a million infections and was associated with approximately 29,000 deaths in 2011,” according to a report published in the New England Journal of Medicine on Feb. 25, funded by the CDC. A majority of the sick caught the infection from health care. “ Of these cases, 65.8 percent were health care–associated, and 24.2 percent were hospital-onset,” according to the report.
The authors wrote that “The magnitude and scope of Clostridium difficile infection in the United States continue to evolve.” That is true of all the superbugs.
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