Antibiotic Resistant CRE Infections Are Emerging Threat, CDC Warns

Government researchers indicate that the U.S. healthcare system faces a growing threat from antibiotic-resistant “super bugs” that have emerged in recent years, which have already resulted in several hospital infection outbreaks. 

In a report published in the Journal of the American Medical Association (JAMA) on October 5, researchers with the U.S. Centers for Disease Control and Prevention (CDC) indicate that they found higher-than-expected numbers of carbapenem-resistant Enterobacteriaceae (CRE) in some major U.S. cities, suggesting that the drug-resistant infections are an emerging threat.

While some cities showed lower-than-expected infection rates, cities like Baltimore, New York and Atlanta raised the overall national incidence rate to 2.93 per 100,000 people. The researchers said that while that rate is still much lower than more common types of infections, it does indicate that CRE infections, more commonly referred to as “super bugs”, appear to be becoming more commonplace.

Researchers gather their data from population and laboratory-based surveillance of CRE among people living in seven U.S. metropolitan areas in 2012 and 2013, finding 599 CRE infection cases during that time period.

In addition to the overall incidence rate, researchers found that it appears many of the cases were hospital-acquired infections, and that some hospitals may have accidentally transferred the bacteria between facilities. The findings also suggest that about 9% of cases ended in patient deaths.

“Hospitalization around the time of the positive CRE culture was common among cases, with the majority among surviving individuals, resulting in discharge directly to a long-term care facility or a long-term acute care hospital” because the patients are generally older and have other health problems, the CDC researchers noted. “The frequent movement of these individuals across the continuum of care underscores their important role in the interfacility spread of CRE, especially if CRE status is not communicated to accepting facilities as part of the transfer process.”

Duodenoscope CRE Infections

A number of duodenoscope hospital infection outbreaks were reported earlier this year, including an outbreak of CRE that occurred at UCLA’s Ronald Reagan Medical Center in February. The outbreak caused at least seven infections, two deaths, and raised concerns that nearly 200 other patients had been placed at risk by duodenoscopes manufactured by Olympus Corp.

Duodenoscopes are used in endoscopic retrograde cholangiopancreatography (ERCP) procedures, but difficulties cleaning the devices between patients have resulted in a number of recent outbreaks of antibiotic-resistant hospital-acquired infections in recent years.

The duodenoscope CRE infections have been linked to problems with the “reprocessing” instructions used to clean the devices for use by another patient. FDA reviewers determined that the instructions sent out at the time were inadequate and that even if the recommended steps were followed to clean ERCP endoscopes, flaws in the design may allow them to become easily contaminated.

On the same day this latest study was published, the FDA ordered duodenoscope manufacturers to conduct new postmarket surveillance studies to try to better identify infection problems related to the medical scopes.

In August, the FDA issued a safety communication expanding cleaning instructions for duodenoscopes used in ERCP procedures. Olympus Corp. issued expanded cleaning instructions which were approved by the FDA earlier this year.

Several duodenoscope infection lawsuits have already been filed  against Olympus over the infections linked to the UCLA outbreak. The complaints allege that design problems that make the scopes especially difficult to clean, placing patients at higher risk of contracting illness.