What You Should Know About ‘Superbug' CRE

By Kathleen Doheny
WebMD Health News

Reviewed by Brunilda Nazario, MD

Feb. 20, 2015 -- The ''superbug'' infection at the heart of an outbreak at Ronald Reagan UCLA Medical Center in Los Angeles is sometimes called "the nightmare bacteria" because it's so resistant to antibiotics.

Two deaths at the California medical center are linked to the bacteria, known as CRE, or carbapenem-resistant Enterobacteriaceae. Five other patients are infected and nearly 200 may have been exposed, the center says. Exposure stemmed from two contaminated instruments used during procedures done over the past few months at the facility.

WebMD turned to two experts and the CDC to find out more about CRE.

What is CRE and how does it spread?

CRE is in a family of bacteria that are normally found in the gut and have become resistant to antibiotics. They are resistant to most of the available antibiotics, says Stephen Calderwood, MD. He's the president of the Infectious Diseases Society of America and chief of the infectious disease division at Massachusetts General Hospital, Boston.

The devices linked with the UCLA outbreak, known as duodenoscopes, are used in more than 500,000 procedures a year in the U.S., according to the CDC.

The scope is inserted into the mouth and through the throat, stomach, and the top of the small intestine. It helps doctors diagnose and treat diseases of the liver, bile ducts and pancreas. The FDA warned that the scopes might still carry a risk of infection even after proper cleaning procedures.

The problems can start when the bacteria leave the intestine and live in other areas, such as the urinary tract, lungs, skin, and on medical equipment, Calderwood says. "They mainly cause infections when they get to a certain number and the ability of the body to fight off infection breaks down."

Who is most at risk?

"Most healthy people don't get these infections," says Robert Glatter, MD. He's an emergency medicine doctor at Lenox Hill Hospital, New York. "It's the people living in long-term care facilities, nursing homes, or who have long hospital stays."

Those who get infected often have other diseases, are on antibiotics, and have had a procedure involving a medical device, Calderwood says.

How common is it?

During the last decade, CRE infections have been reported in 42 states, according to the CDC. About 4% of U.S. hospitals had at least one patient with a CRE infection in the first half of 2012, the agency found, while about 18% of long-term acute care hospitals did.

How deadly is it?

Very. About 40% to 50% of those infected may die, the CDC says, according to some studies. Up to half of those who get CRE bloodstream infections die. CRE is much harder to treat than other deadly infections, including those caused by MRSA and C. diff (Clostridium difficile), Glatter says

''The bacteria overwhelm the body," Glatter says. "It can happen over a period of days or it can linger for weeks."

Calderwood says since the infections tend to happen in those who are sick already, the CRE infection may be one of many factors contributing to their deaths.

In a 2013 report, the CDC called CRE an urgent health threat.

How is CRE infection treated?

Doctors often try antibiotics known as carbapenems along with another antibiotic, Calderwood says. Often more than one antibiotic is needed, he says.

What precautions can people take?

"This is really a hospital-acquired infection," Calderwood says. "It's not really a risk for the average person [in the community].''

When you're getting treated in a hospital, you can expect doctors, nurses, and other health care providers to wash their hands with soap and water or an alcohol-based rub before and after tending to you or to any tubes attached to you, the CDC says. But also tell your doctor if you've had recent hospital stays in another facility or another country, the CDC says.


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SOURCES: CDC: "Carbapenem-resistant Enterobacteriaceae in Healthcare Settings." FDA Safety Communication: "Design of Endoscopic retrograde Cholangiopancreatography (ERCP) Duodenoscopes May Impede Effective Cleaning." Stephen Calderwood, MD, president, Infectious Diseases Society of America; professor of medicine, Harvard Medical School, and chief of infectious disease, Massachusetts General Hospital. Robert Glatter, MD, emergency medicine physician, Lenox Hill Hospital, New York. CDC: "Antibiotic Resistance Threats in the United States, 2013." CDC: "Guidance for Control of Carbapenem-resistant Enterobacteriaceae 2012 CRE Toolkit."

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