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'Nightmare bacteria' has significantly lower death rate, new report says

So-called "nightmare bacteria" apparently affect women at a slightly higher rate than men and are occurring at a greater rate in some parts of the country -- but at significantly lower mortality than previously reported, government scientists said Tuesday.

The new data, which appear in the online edition of the Journal of the American Medical Association, report a death rate of 9 percent, down from 40 percent and sometimes 50 percent over the past two years, according to the Centers for Disease Control and Prevention. The new data are based on the CDC's observations in seven communities. Buffalo was the only city in New York that was part of the research.

Nightmare bacteria -- CRE or carbapenem-resistant Enterobacteriaceae -- are resistant to virtually every antibiotic on pharmacy shelves, including the drugs of last resort.

New York City has the largest incidence of CRE in the state, according to the state Health Department, which has found that Long Island has half the incidence of the metro area. Only one state hospital-acquired infection report has been released to date containing information on the incidence of CRE in New York. That report, released in December, found more than 3,000 cases in 2013.

State officials have found upstate hospitals to have substantially lower rates of CRE compared with those in this region.

"We have pre-established catchment areas," said Dr. Alexander Kallen, senior author of the report and a CDC medical officer. His report changes the narrative on CRE's mortality while underscoring the threat posed by the bugs.

He identified the catchment areas as part of the agency's Multisite Gram-negative Surveillance Initiative Network: New York, Colorado, Georgia, Maryland, New Mexico and Oregon.

Gram-negative bacteria are among the worst infectious agents, and there are a dwindling few antibiotics that still work against them.

CRE was given the name nightmare bacteria two years ago because of its extraordinary death rate and its capacity to repel the carbapenem class of antibiotics.

Kallen, however, said Tuesday the new data serve as a measure of CRE going forward.

"This is the first time that I am aware that we actually have rates so this is our baseline," he said, noting that CRE increased fourfold from 2001 to 2011.

CRE was first reported in a cluster of Brooklyn hospitals in 2001.

New York hospitals were the first to link the bacteria to high mortality. Tuesday's report said urinary tract infections are the most common form of CRE infections followed by those of the bloodstream.

This summer the CDC reported the main mode of transmission has been from long-term care facilities to hospitals, usually by colonized patients who spread the infection unwittingly. However the incidence of the bacteria in nursing homes and long-term care institutions is not part of statewide surveillance, which assesses only those cases that occur in hospitals.

Former New York lieutenant governor Betsy McCaughey, who's now head of RID, a Manhattan nonprofit she founded more than a decade ago to fight hospital-acquired infections, told Newsday that unless CRE incidence in long-term care facilities is counted, data are incomplete.

"Nursing homes and other facilities have to be counted, no question about it," she said.

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