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March 2013
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CDC Raises Alarm on Rising CRE Rates, Stresses Prevention

More inpatients are suffering from infections caused by carbapenem-resistant Enterobacteriaceae (CRE) in health facilities across the country, according to a Vital Signs report released by the Centers for Disease Control and Prevention (CDC) earlier this month. Using data from several national surveillance systems, the report showed:

  • About 4 percent of acute-care hospitals and 18 percent of long-term acute-care hospitals reported at least one patient with a CRE infection in the first six months of 2012.
  • Carbapenem resistance, while still relatively uncommon among Enterobacteriaceae, has increased from about 1 percent to 4 percent during the past decade.
  • Forty-two states have reported at least one patient who has tested positive for one type of CRE. Almost all CRE infections occur in people receiving significant medical care in hospitals, long-term acute care facilities, or nursing homes.
  • CRE bloodstream infections are associated with mortality rates approaching 50 percent.

“CRE are nightmare bacteria,” CDC Director Tom Frieden, MD, MPH, said in a CDC press release. “Our strongest antibiotics don’t work and patients are left with potentially untreatable infections. Doctors, hospital leaders, and public health must work together now to implement CDC’s ‘detect and protect’ strategy and stop these infections from spreading.”

A CDC-developed toolkit on CRE prevention for health facilities and state health departments is available online. Recommendations include:

  • Know if patients with CRE are hospitalized at your facility, and stay aware of CRE infection rates. Ask if patients have received medical care somewhere else, including another country.
  • Follow infection control recommendations with every patient, using contact precautions for patients with CRE. Whenever possible, dedicate rooms, equipment, and staff to CRE patients.
  • Prescribe antibiotics wisely. Use culture results to modify prescriptions if needed.
  • Remove temporary medical devices as soon as possible.

The CDC report generated significant media coverage, including a front-page USA Today article, which noted the lack of antibiotic development and little financial incentive for companies to pursue antibiotic research and development, issues IDSA has been working to address for many years, including though the 10 x ’20 initiative.“It’s an issue of public health,” IDSA Board Member Helen Boucher, MD, FIDSA told USA Today. “We all have to be part of the solution.”

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