Posted on 01/06/2018 8:18:18 PM PST by bitt
A report today from the Centers for Disease Control and Prevention (CDC) on a small outbreak of carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) at a Kentucky hospital in 2016 highlights multiple introduction of the worrisome pathogen in a rural facility and demonstrates the possible role of cleaning equipment.
The investigation by physicians and epidemiologists from the CDC and the Kentucky Department of Health, appearing today in the CDC's Morbidity and Mortality Weekly Report (MMWR), describes an outbreak that started on Aug 11, 2016, when two Klebsiella pneumoniae carbapenemase (KPC)-producing isolates from clinical cultures were reported from patients in a small community hospital in rural Kentucky.
Over the next 4 months, scientists identified an additional 21 CRE isolates from patients at the hospital via screening and clinical cultures. The investigators believe organisms were imported into the facility and then spread among patients.
CRE have been dubbed "nightmare" bacteria because they are resistant to most antibiotics and spread easily from person to person in hospital settings. In addition, carbapenem resistance mechanisms like KPC—the most common carbapenemase enzyme found in CRE samples in the United States—are carried on mobile pieces of DNA called plasmids and can be shared with other types of bacteria, potentially driving wider and more rapid spread of carbapenem resistance. The CDC estimates that more than 9,000 healthcare-associated CRE infections occur each year in the United States.
Invasive CRE infections can be severe and deadly in critically ill patients, with mortality rates as high as 50%. More often, however, patients identified as CRE carriers are asymptomatic. But these colonized patients can still transmit the organism to other patients.
Importation and transmission Of the 23 CP-CRE isolates identified, 17 (74%) were detected through screening cultures and the rest from clinical cultures. Further analysis of 14 available isolates revealed that 12 were K pneumoniae and two were Escherichia coli; in addition, 13 of the isolates produced the KPC enzyme and one produced the New Delhi metallo-beta-lactamase enzyme.
Pulsed-field gel electrophoresis identified three indistinguishable pairs of isolates that were isolated from patients who had exposure, based on medical chart review and patient interviews, to the emergency department or to the same medical-surgical ward. The investigators believe that's an indication that CP-CRE transmission occurred in these units.
Interviews with 13 of the patients also revealed that five had received healthcare outside the local area. The investigators suggest that 3 of these patients may have introduced CP-CRE into the facility; 2 had CRE identified at screening admission. But environmental cultures also identified CP-CRE on an emergency department environmental services cart and in a floor sink drain in a closet in the involved medical surgical ward.
The authors of the report say their investigation highlights the potential role of cleaning equipment, which frequently moves between patient rooms, in CP-CRE spread. In addition, they note that although there is a low prevalence of CP-CRE in rural areas, rural hospitals should be aware that patients who've also accessed healthcare in areas with higher CP-CRE prevalence—primarily urban areas—can introduce these organisms into their facilities.
The authors suggest that the facility initiate CRE surveillance in patients with known exposure to healthcare in areas with higher CP-CRE prevalence, reinforce daily and terminal cleaning practices, and work with other facilities in their patient-sharing network to implement a CP-CRE control strategy.
See also:
Jan 5 MMWR Notes from the Field
I would just like my doctor or nurse to wash up before an examination. I have seen workers at Subway take better precautions than some medical staff.
Luke, just because you don’t see them doesn’t mean it doesn’t happen. Doctors, nurses, even veterinarians, wash their hands so many times a day they become raw. You do know that microbes are also transferred in air. Ok, there are many airborne infectious diseases, or even close contact within 3-6 feet allows some to spread. And then there is the doorknob, the most common fomite known to spread infectious diseases. Just be grateful you have the best medical industry on the planet. Why do you think so many foreign dignitaries come here for treatment?
Yeah, I’m ready for your sarcastic reply, but it was not necessary because I stated what I have & many others have experienced. Why would you make a legitimate post snarly about the “common people?”
My idea about cleanliness means when you enter my exam room or hospital room.......I don’t care if you’re the janitor, a nurse or the most prestigious surgeon in the world,.....strip off your gloves, throw them away, wash your hands, wipe down your stethoscope & THEN touch me.
I have an autoimmune disease & used to be hospitalized at least once a year long ago. Knock on wood! Never saw the handwashing, & changing of gloves like you say is happening. Neither do others. It is ingrained into us to not question the medical establishment, but we need to start politely requesting that they wash their hands every time they come into the room. I say this with great respect for many of the wonderful people who have treated me.
Why do you go there then? No one is forcing you to go. Too many people gripe about everything and everyone but themselves.
What others experience often bears little resemblance to the truth or what they think is reality. I cite the back to back election of a Marxist Muslim to the WH as a prime example of what people thought was going to make a great president.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.