Nursing Home Patients May Carry Drug-Resistant Bacteria Into Hospitals: Study

New research suggests that some nursing home patients may carry antibiotic-resistance bacteria to hospitals when they are taken for other medical concerns, potentially placing other hospital patients at risk of severe and potentially deadly infections.

Researchers tested 400 nursing home patients for the “super-bug” carbapenem-resistant Enterobacteriaceae (CRE) during hospital admissions, indicating that the antibiotic-resistant bacteria was found in about five percent of the patients transferred from a nursing home.

The case controlled study was published online by the American Journal of Infection Control on November 26, examining hospital admissions to The Rhode Island Hospital and The Miriam Hospital in 2012, involving 500 admissions from nearby nursing homes in Providence, Rhode Island.

Nearly five percent of patients tested positive for CRE, or the carbapenem producing gram-negative bacteria, even though the patients showed no symptoms of infection caused by carrying the bacteria.

Out of seven patients who were positive for CRE, two were positive for the Klebsiella pneumoniae carbapenemase producing Citrobacter freundil strain, and one patient tested positive for carbapenem susceptible by standard testing methods.

In October, the U.S. Centers for Disease Control and Prevention (CDC) highlighted the increasing threat of CRE infections to the U.S. healthcare system, following a number of hospital infection outbreaks in recent years. The CDC found high numbers of CRE infections in seven major cities across the country, indicating that about nine percent of cases ended in patient deaths.

These “super bug” infections put other patients at risk of also being infected by similar drug resistant bacteria that hospitals don’t realize some patients are carrying into the hospital setting.

The study revealed the use of feeding tubes were associated with gastrointestinal carriage of the CRE bacteria. Researchers say the results of the study highlight the importance of hospital and nursing home infection control practices and controlling the spread of the dangerous CRE bacteria.

Patients with drug resistant bacteria that are admitted to hospitals place other patients at risk, because the likelihood of the bacteria spreading is often high. Researchers indicate that the data offered in this latest the study allows researchers and doctors to determine the risks and benefits of using feeding tubes in different patient populations, especially among nursing home patients.

Overall, very little data concerning the prevalence of antibiotic resistant bacteria exists in medical literature, researchers warned, especially among nursing home patients showing no symptoms at the time of admission to hospitals.

Duodenoscope CRE Infections

Earlier this year, a CRE superbug infection outbreak surfaced at UCLA Medical Center in Los Angeles, leading to nearly 200 patients being tested for the bacteria after two deaths and at least seven reported infections among patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) procedures.

The outbreak was traced back to “reprocessing” instructions used to clean duodenoscopes between patients, with FDA reviewers determining that the cleaning steps recommended by the manufacturer were insufficient to prevent the spread of the superbug, as flaws in the design may allow them to become easily contaminated.

The FDA has required new mandatory studies will help the agency analyze the effectiveness of the current cleaning instructions and how they are implemented in real-world hospital settings.

In August, the FDA posted a warning letter to Olympus, the manufacturer of the duodenoscope involved in the UCLA infection outbreak, indicating that the company had failed to report links between the company’s devices and serious patient infections, injuries and deaths. Two other duodenoscope manufacturers, Pentax and Fujifilm, also received FDA warning letters.

The letters, issued on August 12, suggest that duodenoscope makers knew for years that their devices were linked to infection outbreaks, but failed to warn the FDA or address the problem. The companies are also currently under investigation by the Department of Justice.

In May, an FDA advisory committee determined that the devices “do not provide a reasonable assurance of safety and effectiveness” due to the difficulty cleaning them. The panel said that manual cleaning is still important and needs to continue, but also recommended that the FDA reclassify duodenoscopes from semi-critical medical devices to critical medical devices and said reprocessing needs to be taken from “high level disinfection” processes to full sterilization.

Despite the concerns, the panel also determined that the benefits provided by ERCP procedures still outweigh the risks associated with the use of duodenoscopes. They called on the FDA to develop a guide of best practices to make sure that manufacturer instructions are followed, in addition to the need for better instructions overall.

Also 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.