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NY health officials monitoring 3 cases of 'nightmare bacteria' in Nassau County

In this undated photo provided by the Centers

In this undated photo provided by the Centers for Disease Control and Prevention is one form of CRE bacteria, sometimes called "nightmare bacteria." CRE bacteria is blamed for 600 deaths each year, and can withstand treatment from virtually every type of antibiotic. Credit: AP

State health officials say they're monitoring three cases of so-called nightmare bacteria in Nassau County, a sometimes-deadly multidrug-resistant strain that is causing infections worldwide.

There have been 10 outbreaks of CRE -- carbapenem-resistant Enterobacteriaceae -- statewide since 2012, according to the state Health Department, and there were at least 3,000 cases identified statewide during a pilot study of all state hospitals.

The state said the local cases were reported by Nassau University Medical Center on Feb. 20. However, Dr. Victor Politi, chief executive at NUMC, said there was no outbreak at his hospital and that the only cases of which he is aware involved "chronically ill patients on ventilators."

"These were not infections, they were colonizations," Politi said.

The pathogens are so pervasive throughout the local population, they're now considered "endemic," meaning that people may be colonized carriers and not know it.

Mary Ellen Laurain, spokeswoman for the Nassau County Department of Health, denied the presence of CRE at NUMC, saying "at the present we have no cases under investigation, but we continue to conduct active surveillance."

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CRE kills about 40 percent of people who contract the bacteria because doctors are running out of effective antibiotics. Concerns about CRE in New York come as federal health officials continue to investigate endoscopic tubes as a source of infections nationwide. Federal authorities now say the design of certain endoscopic tubes may be so complex that the devices can't always be properly disinfected.

The tubes have been associated with a series of outbreaks in recent years involving the deadly multidrug-resistant bacteria.

No endoscopic tube-related infections have been identified in New York.

CRE is a notorious cause of pneumonia, urinary tract and bloodstream infections. The bacteria have been carried by colonized patients from one medical facility to another.

This past week, the U.S. Food and Drug Administration noted that the design of the widely used tubes "may impede effective cleaning." The tubes are used in a procedure known as endoscopic retrograde cholangiopancreatography, or ERCP. Hundreds of ERCP procedures are performed at Long Island hospitals annually, doctors say.

The FDA is recommending that doctors "inform patients about the benefits and risks associated with ERCP procedures." And that patients contact their physicians immediately if fever, chills or abdominal pain arise after an endoscopic procedure.

The highly specialized device, known as a duodenoscope, is a flexible fiber-optic tube that is inserted through the mouth and down the throat and is used to treat conditions of the upper gastrointestinal tract, usually problems of the bile and pancreatic ducts.

"These tubes are not disposable," said Dr. Mark Jarrett, chief quality officer for the North Shore-Long Island Jewish Health System, underscoring that they must be disinfected by hand, then reused.

"They're very expensive and we have always followed the manufacturer's guidelines and gone beyond that in our cleaning processes, especially since this issue has come to the forefront.

"We have been actively auditing our processes and feel comfortable at this time in ensuring that the scopes are appropriately cleaned at all of our sites."

The North Shore-LIJ system includes 19 institutions. Not all perform ERCP, Jarrett said.

Dr. Paul Mustacchia, a gastroenterologist and chairman of medicine at NUMC, said his hospital also follows strict guidelines involving the tubes' disinfection. Next week, he said, representatives from Olympus Corp., makers of one of the most widely used endoscopic tube brands, will be at NUMC to discuss additional disinfection methods with medical personnel.

Francina Singh, a registered nurse and director of health care epidemiology at Stony Brook University Hospital, said in a statement Friday there have been no problems related to the endoscopes at her institution.

"Stony Brook Medicine follows current professional society guidelines on reprocessing flexible gastrointestinal endoscopes," Singh said. "We assess the process twice a year, which is above the current recommended standard. We also monitor all our patients post-endoscopic-procedure."

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