The good news, Frieden said, is that facilities still have time to prevent CRE from emerging or to control it if it has.
Nearly 200 short-stay and long-term acute-care hospitals reported at least one case of CRE during the first six months of 2012, the CDC said in its report.
Incidences of CRE have climbed from 1.2% of all Enterobacteriaceae infections in 2001 to 4.2% in 2011. One type of CRE, Klebsiella pneumoniae carbapenemase, or KPC—linked to a 2012 outbreak that claimed the lives of eight patients at the National Institutes of Health Clinical Center, Bethesda, Md.—has increased sevenfold, from 1.6% to 10.4%, over the past decade, the CDC said.
CRE kills up to half of patients who get bloodstream infections from it, according to federal data.
“It's not nearly as widespread as MRSA,” said Frieden, referring to the drug-resistant infection methicillin-resistant Staphylococcus aureus, “and it's important that we keep it that way.”
Some facilities have taken a proactive approach, he added, implementing evidence-based practices and ramping up surveillance.
At the 467-bed University of Colorado Hospital, Aurora, for instance, CRE has been on the radar for some time, and specialized protocols have been integrated into standard practice, said Dr. Michelle Barron, the hospital's medical director of infection prevention and control.
The University of Colorado Hospital treated its first patients with KPC five years ago, Barron said. “We knew it was coming,” she said. “We had heard about infections on the coasts and we knew it was out there.”
The hospital had a system in place that flagged any patient shown to be infected with a resistant organism. That alert then triggered stepped up contact precautions—such as gloves, gowns and private rooms—and extra attention to antibiotic use, Barron added.
The infection prevention staff was on the lookout for more cases but saw none until last year, when the hospital identified three patients with CRE. All of the patients' infections were in their lungs—rather than in their bloodstream, which is linked to much worse outcomes—and all the patients recovered well, Barron said. But the three cases prompted the hospital to undertake a comprehensive review of its policies and procedures.
“We did a massive review in conjunction with the health department, looking at our protocols for isolation, hand hygiene and cleaning,” she said.
Barron said the hospital used a tool kit released last year by the CDC, whose recommendations include good antibiotic stewardship and the use of dedicated rooms, staff and equipment for CRE patients. “It was helpful and we thought there was no sense in reinventing the wheel,” she said.
Dr. Alex Kallen, a medical officer at the CDC, said the agency's recommended strategy boils down to “detect and prevent,” or identifying patients through the use of cultures and then applying the appropriate precautions.
Kallen said the CDC is emphasizing a more regional approach to prevention, urging hospitals to communicate regularly with local health departments and nearby healthcare facilities. “In the past, control of (multidrug-resistant organisms) has been very facility-specific without a lot of thought to what's going on outside,” he said. “We've come to realize that a better approach is having facilities work together.”
He also acknowledged that the CDC had altered its usual strategy by issuing the call to action while CRE was still relatively uncommon.
“We don't want to see what happened with (Clostridium difficile) and others with this bug,” Kallen said. “The time to intervene is now.”
