Last week, CDC Director Thomas Frieden opened a press briefing by saying, “It’s not often that our scientists come to me to say that we have a very serious problem, and we need to sound an alarm.” What scientists found, and reported in CDC’s Morbidity and Mortality Weekly Report, is that a growing proportion of Enterobacteriaceae (a family of bacteria known for causing hospital-acquired infections) are resistant to carbapenems, a type of antibiotics that’s typically been the last line of attack against stubborn infections. Frieden explained why these carbapenem-resistant Enterobacteriaceae (CRE) are a “nightmare bacteria”:
They pose a triple threat. First, they’re resistant to all or nearly all antibiotics. Even some of our last-resort drugs. Second, they have high mortality rates. They kill up to half of people who get serious infections with them. And third, they can spread their resistance to other bacteria. So one form of bacteria, for example, carbapenem-resistant klebsiella, can spread the genes that destroy our last antibiotics to other bacteria, such as E. coli, and make E. coli resistant to those antibiotics also. E. coli is the most common cause of urinary tract infections in healthy people. So we only have a limited window of opportunity to stop this infection from spreading to the community and spreading to more organisms.
In the first half of 2012, CRE infections were only reported in 4.6% of US acute-care hospitals; what’s troubling is the rate of increase. We have a limited window of opportunity to stop CRE from becoming widespread and getting out into community settings. The key is for hospitals to act swiftly and implement recommendations from CDC’s CRE Toolkit. These include detecting and communicating about patients’ CRE infections; enforcing infection-control measures; and grouping patients with CRE together and reserving staff and equipment to treat them.
But an important point is that none of this is required, and none of this is funded. When the Netherlands wanted to beat back the emergence of MRSA, that country passed laws requiring every hospital to test patients before letting them in the door. (That story is told in this book.) When Israel wanted to counter KPC, which was ripping through its hospitals after arriving from the US, it created a national task force and imposed mandatory national measures for detecting and confining the infection. (That program is described in this 2011 paper.) And hospitals are on their own in figuring out how to organize and pay for CRE control. There are no reimbursements, under Medicare, for infection-control as a hospital task; and as infection-prevention physician Eli Perencevich demonstrated two years ago, the National Institutes of Health is not funding resistance-countering research.
If we don’t act now, we’re setting ourselves up for a future in which a minor surgical procedure and short hospital stay carries a high risk of catching an incurable infection — and even people who go nowhere near a hospital could pick up a deadly bacteria.