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‘We Have a Limited Window of Opportunity’: CDC Warns of Resistance ‘Nightmare’

‘We Have a Limited Window of Opportunity’: CDC Warns of Resistance ‘Nightmare’

It’s not often that you get to hear a top federal health official deliberately deploy a headline-grabbing word such as “nightmare,” or warn: “We have a very serious problem, and we need to sound an alarm.”

Dr. Thomas Frieden, director of the US Centers for Disease Control and Prevention, said both Tuesday, during a press conference announcing new CDC statistics on the advance of the highly drug-resistant bacteria known as CRE. His language — plus the fact that he conducted the entire press conference himself, instead of just making a brief opening statement — seem to me a clear signal that the CDC is taking this resistance problem seriously, and hoping we do too.

And we should. Here’s what the CDC announced Tuesday:

Healthcare institutions in 42 states have now identified at least one case of CRE.
The occurrence of this resistance in the overall family of bacteria has risen at least four-fold over 10 years.
In the CDC’s surveillance networks, 4.6 percent of hospitals and 17.8 percent of long-term care facilities diagnosed this bug in the first half of 2012.

Those are dire reports.

Here’s some back-story: CRE stands for “carbapenem-resistant Enterobacteriaceae.” Enterobacteriaceae are a family of more than 70 bacteria which share the characteristic of being gut-dwelling (“entero”); they include Klebsiella, Salmonella, Shigella and E. coli. Carbapenems are a “last-resort” family of antibiotics — imipenem, meropenem, doripenem and ertapenem — which are used against these bacteria when they have become resistant to other drugs. (Carbapenem resistance is conferred by a number of different genes and so sometimes goes by a number of other acronyms, including KPC, VIM, OXA and the “Indian superbug” NDM-1.)

CRE tends to attack in ICUs and other critical care, and also in rehab units and nursing homes. That is for several reasons. First, because patients in those settings are uniquely vulnerable to infection, not just because of their illness but because the protective barrier of their skin has been breached by ports and catheters, and also because they are visited and touched by a lot of people. Second, because they are likely to be receiving heavy-duty antibiotics which put the bacteria in their bodies under evolutionary pressure. Third, because those drugs plus others cause diarrhea, which spreads gut-dwelling bacteria into the air and area. And fourth, because those bacteria are particularly good at surviving on the kind of surfaces — plastic, glass and metal — that you find in health care.

Carbapenem resistance first appeared in the US in 1996, in a single sample containing KPC that the CDC found in a hospital in North Carolina. By the early 2000s, it was causing significant outbreaks in hospitals in New York City; from there, it spread with New Yorkers to “snowbird” vacation locations, and then to Israel, and then started moving around the globe. (You can read that history in a piece I did for Scientific American in April 2012; and my past posts on all this are here.)

The map of CRE in the US now looks like this, as released by the CDC yesterday. Among the outbreaks represented on that map are the “NIH superbug” outbreak last year (described in these two posts and by Carl Zimmer on the magazine side of Wired), and also an outbreak of NDM-1 in a Rhode Island hospital in 2011. But — and the CDC acknowledges this — the map is probably an understatement, for several reasons. CRE is not what public health calls a “reportable disease”; according to the CDC, only six states require that physicians or hospitals tell the rest of the world they have diagnosed it. (Three others are “considering” making it reportable.) Plus, surveillance for CRE is patchy; yesterday’s CDC report comprised data from three different surveillance systems. And also, there are carbapenem-resistant bacteria causing outbreaks in the US which are not counted as CREs because the bacteria are not Enterobacteriaceae. For one example, take a look at the breathtaking trend line in this map of carbapenem-resistant Acinetobacter, put together by the ResistanceMap project at the Center for Disease Dynamics, Economics and Policy. [Read Entire Article From The Source]

Article By Maryn McKenna | Source WIRED | Read More By Maryn McKenna


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