Battling superbugs

The specter of superbugs spreading through U.S. hospitals has public health experts debating how hospitals should 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're not going to win a war with them because they will never stop adapting to what we throw at them,” said Dr. Brad Spellberg, an infectious disease specialist at Los Angeles Biomedical Research Institute. “We have to find a way to coexist. We need a plan of action.”

The CDC 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 others aren't—testing for mechanisms and regular reporting through their microbiology lab,” said CDC medical officer Dr. Alex Kallen, who was responsible for overseeing the Illinois outbreak.

Last spring, when Advocate Lutheran's microbiology lab started noticing a recurring strain of what was later determined to be carbapenem-resistant Enterobacteriaceae (CRE), the hospital immediately alerted health officials, and every patient who underwent an endoscopic retrograde cholangiopancreatography between January and September 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 showed 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.

Spellberg said efforts that encourage reporting by physicians are one part of the equation, but the U.S. has “scattered pieces of the puzzle in different agencies, and no comprehensive plan.”

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.