There’s a relatively unknown, hidden or “stealth” bug that’s making big problems for some hospitals. It’s called Carapenem-Resistant Enterobacteriaceae.
CRE is listed by the Centers for Disease Control and Prevention as one of the top three bug threats. It has a 50 percent mortality rate.
“We call it a triple threat bug because it’s resistant to almost all antibiotics, it can spread easily within our bodies making other organisms resistant, and it has a high mortality rate when patients become infected,” explains Jeffrey Band, M.D., Beaumont Health System chair of Epidemiology and International Medicine. “It tends to strike more patients with compromised immune systems and with significant underlying diseases.”
The “nightmare bug” as some have called it, emerged in the late 1990s and by the 2000s became endemic in many hospitals located in Los Angeles, New York City and Chicago. By the late 2000s, doctors began seeing outbreaks and are continuing to see more.
As with many superbugs, infectious disease experts point to the overuse of antibiotics as one of the major causes of CRE.
“When a patient is given antibiotics to get rid of an infection, CRE waits for the primary bacteria to die and then comes forward,” explains Dr. Band. “What results is an infection with a very resistant bacteria that can inactivate our last class of antibiotics previously reserved for other resistant organisms.”
A growing health threat, antibiotic resistance occurs when a germ mutates and is no longer affected by medicine. Common superbugs such as MRSA, have received a lot of attention recently, so drug manufacturers have tilted their research toward antibiotics that focus on bacteria in the gram positive category, such as MRSA.
CRE is a gram negative bacterium.
“Antibiotic resistance is one of the greatest threats to humans worldwide,” says Dr. Band. “I have several options for treating MRSA. For CRE, I possibly have one older antibiotic that we stopped using in the 1970s because of serious side effects. There is little in the pharmaceutical pipeline and nothing on the immediate horizon.”
Because options are limited, Dr. Band and his team of infection preventionists have instituted an aggressive prevention program to identify patients at risk for carrying CRE.
They also limit antibiotic use to only what will work specifically for a particular infection. “We use the least toxic medicine with the narrowest spectrum for no longer than necessary. This helps prevent the emergence of a resistant bug,” adds Dr. Band.
The final step to keeping CRE at bay is to put the colonized or infected patient into strict or enhanced contact precautions.
While CRE is deadly, it’s rather passive. In patients who have the bacteria, only 25 percent will develop an active infection.
“Because only one in four people develop illness from CRE, very few hospitals have a screening program in place and a lot of hospitals don’t use contact precautions,” says Dr. Band. “But when this bug does activate, fighting it is like practicing medicine in the pre-antibiotic era. So, we have to be proactive, not reactive.”