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CDC sounds alert on antibiotic-resistant ‘nightmare bacteria’

Carbapenem-resistant Enterobacteriaceae or

Carbapenem-resistant Enterobacteriaceae or "nightmare" bacteria are shown via electron micrographic imagery. Credit: AP / Centers for Disease Control / Melissa Brower

Deadly “nightmare bacteria” that are resistant to most antibiotics were identified in 221 instances nationwide last year in an intensive surveillance program aimed at stopping superbugs before they spread, federal health officials said Tuesday.

These resistant bacterial strains — formally known as CRE, which stands for carbapenem-resistant Enterobacteriaceae — can colonize medical equipment and adhere to the hands of health-care workers.

Hospital environmental experts highlight that key “touch points” also may be sources of contamination: hospital beds, curtains, bedside trays, telephones and other surfaces in hospital rooms.

The bacteria have developed unique genetic mechanisms that allow them to repel multiple families of antibiotics, including the carbapenem class, which are considered the drugs of last resort.

Dr. Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention, said federal and state health officials found evidence of unique mutations in nightmare strains during the surveillance and then isolated patients before the bacteria spread.

Nightmare bacteria can cause pneumonia, bloodstream and urinary tract infections. The death rate from the organisms is estimated at about 50 percent.

Because the bugs are difficult to treat, they threaten hospitalized patients who need antibiotics most: cancer patients, organ recipients, children with cystic fibrosis and people with other forms of immune suppression.

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Antibiotic resistance of all kinds, not only CRE, affects 2 million people annually in the United States and kills about 23,000, she said during a teleconference Tuesday afternoon.

The World Health Organization has declared resistance to antibiotics an explosive global threat and CRE — nightmare bacteria — are at the epicenter of concern.

Schuchat said many people who are infected with such strains “are virtually untreatable with modern medicine.”

In New York, CRE incidence in hospitals must be reported to the state Health Department and the data is made available to consumers annually in a Hospital-Acquired Infections Report.

A 2015 map of CRE incidence in the state — the most recent year for complete data — showed the largest concentration of cases was in New York City. A lesser incidence was evident on Long Island and in Westchester County. Most of upstate New York had barely any incidence of nightmare bacteria.

The CDC’s National Healthcare Safety Network, which works with state and local health departments, reported being successful last year in isolating infected patients, though not all of them survived, officials said.

“These germs do more than spread and cause infections; they can share their genes with [unaffected] bacteria,” Schuchat said.

Dr. Arjun Srinivasan, also of the CDC, stressed the importance of aggressively pursuing all cases of nightmare bacteria and of isolating patients to prevent the emergence of new genetic subtypes.

“Samples are tested for a number of resistance genes,” Srinivasan said. “When you have something that’s unusual, that presents the greatest opportunity to prevent it from spreading.”

Schuchat and other experts noted Tuesday that while the sickest patients are the most vulnerable, healthy people can be carriers of these superbugs.

She and Srinivasan emphasized the importance of hand-washing, the wearing of gloves by health-care workers, and isolating affected patients.

The CDC’s surveillance program found many instances of nightmare bacteria “hiding in plain sight,” Schuchat said.

For example, endoscopic tubes used by doctors to examine the upper gastrointestinal tract were voluntarily recalled two years ago because their design made them virtually impossible to clean. The devices harbored nightmare bacteria and were the cause of outbreaks worldwide.

The National Healthcare Safety Network is working with hospitals and other health-care facilities as a way to save antibiotics from becoming obsolete.

“Antibiotics are safety-net drugs,” Schuchat said, and without their ability to fight off the bacteria, medical care faces a frightening future.

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