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Carbapenem-resistant Enterobacteriaceae, or CRE, seen through a microscope
Carbapenem-resistant Enterobacteriaceae, or CRE, seen through a microscope
Photo credit: CDC

'Nightmare bacteria' outbreak at Illinois hospital holds clues for battling superbugs


By Sabriya Rice
Posted: January 9, 2014 - 2:00 pm ET
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The specter of superbugs spreading through U.S. hospitals has public health experts debating what hospitals should do to deal with such outbreaks. An incident last year in Park Ridge, Ill., may point the way to one approach that could help, according to a report by the Centers for Disease Control and Prevention.

“We have to get past this concept of a war on the superbug,” said Dr. Brad Spellberg, an infectious disease specialist at Los Angeles Biomedical Research Institute and co-author of a 2013 NEJM editorial looking at the future of antibiotics and resistance. “We're not going to win a war with them because they will never stop adapting to what we throw at them. We have to find a way to coexist; we need a plan of action.”

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The CDC encourages healthcare workers to follow available guidelines, especially regarding proper use of antibiotics. The agency points to a new report concerning an outbreak of the “nightmare bacteria” at Advocate Lutheran General Hospital in Park Ridge as a “very exciting and novel change in how we approach the organism," both in terms of coordinated regional response and hospital procedures.

“This outbreak came to light because the hospital was doing something a lot of other's aren't—testing for mechanisms and regular reporting through their microbiology lab, a resource often underutilized,” said CDC medical officer Dr. Alex Kallen, who was responsible for overseeing the Illinois outbreak.

In the spring of 2013, when Advocate Lutheran's microbiology lab started noticing a recurring strain of what was later determined to be carbapenem-resistant Enterobacteriaceae (or CRE), the hospital immediately alerted health officials, and every patient who underwent an endoscopic retrograde cholangiopancreatography between January and September of 2013 was notified and screened. The particular strain, one that produces the NDM enzyme, making it resistant to a broad range of antibiotics, is uncommon in the U.S. Of the 44 reported cases of the NDM strain, 38 of the patients had undergone the procedure at Advocate Lutheran.

“The important thing is recognizing the slow emergence of these bacteria,” Kallen said. “This kind of bug was recognized even though it was still uncommon in the U.S., and that's when you want to intervene.”

Still, a CDC chart (PDF) paints a vivid picture, showing how CRE—deemed a “nightmare bacteria” because of its high level of drug resistance, association with higher mortality rates and propensity to transfer antibiotic resistance to other bacteria—has spread rapidly, from just one state reporting it in 2001 to nearly all states by 2013.

Critics such as Spellberg say we can expect to see these types of trends continue.

Bacteria vastly outnumber humans, he said. “They outweigh us by 100 million times, and they can replicate 500,000 times faster than we can.” He said efforts that encourage reporting by physicians is only one part of the equation, but the U.S. has “scattered pieces of the puzzle in different agencies, and no comprehensive plan that deals with the issue from A to Z.”

Each year, at least 2 million people in the U.S. acquire serious antibiotic resistant infections, and at least 23,000 die, according to the first-ever snapshot of the threats from the CDC.

The agency recently announced four core actions needed to help in the fight—including prevention, tracking, better use of current antibiotic and promoting the development of new antibiotics and diagnostic tests. But some argue that even with those efforts, there's still a long fight ahead in the war on superbugs.


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