I recently read an article that made my skin crawl and my blood boil.
In 2001, North Carolina reported the first case of carbapenem-resistant enterobacteriaceae (CRE), and research shows that there have been thousands of cases of CRE spreading across 41 states.
CRE is unique in that as its name suggests, it's unlike other bacteria, and resistant to carbapenem antibiotics, which are often viewed as the "last line of defense" in treating infection. Compounding this issue is that some patients who test positive for CRE have more than one strain in their bodies. Finally, according to the CDC, because CRE is so difficult to treat, death has been associated in 40 to 50 percent of diagnosed cases.
Peter Eisler, author of the article, states:
Death rates among patients with CRE infections can be about 40 percent, far worse than infections such as MRSA or C-Diff, which have plagued hospitals and nursing homes for decades. And there are growing concerns that CRE could make its way beyond health facilities and into the general community.
And this is where my blood began to boil.
In places like New York, Los Angeles, and Chicago, CRE infections are "endemic," and according to Eisler's report, there isn't "reliable national data" on occurrences in the United States -- even though the CDC has asked states to track it.
So, why aren't states doing it? The issues are vast. Many facilities don't know how to identify CRE, and even if they did, how would they report it within their state's health department? How is the state health department monitoring and keeping track of the data they do collect? And of course, all of this monitoring requires funds.
The CDC says:
In healthcare settings, CRE infections most commonly occur among patients who are receiving treatment for other conditions. Patients whose care requires devices like ventilators (breathing machines), urinary (bladder) catheters, or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are most at risk for CRE infections.
To protect our patients, the CDC has created a CRE Toolkit designed to help healthcare professionals "protect patients and prevent transmission" of CRE. The toolkit offers prevention strategies, and even identifies regions with and without confirmed CRE cases.
Has your facility dealt with CRE? How did you manage it, and limit its effect on patients?