IMAGINE IF a strain of bacteria mutated quickly, swapping genetic
material that provided immunity to the most potent medical weapons.
Now imagine if we didn't know how to identify precisely that strain
or track its spread.
You'd have an idea of the threat Carbapenem-Resistant
Enterobacteriaceae poses for the patients in America's hospitals and
nursing homes.
Such so-called "superbugs" are familiar by now. MRSA -
methicillin-resistant Staphylococcus aureus - depending on the
specific strain, can wreak havoc in the bodies of even healthy
people.
CRE is different. And worse. The death rate from a CRE infection
hovers around 40 percent.
"The bacteria ... are named for their ability to fight off
carbapenem antibiotics - the last line of defense in the medical
toolbox," USA Today reported in November. "And so far, they've
emerged almost exclusively in health care facilities, picking off
the weakest of patients."
The newspaper uncovered a medical system inadequate to tracking
the bug, which is found in at least 41 states and endemic in major
cities and in many states.
Virginia has early experience with an outbreak. Four years ago,
USA Today reported, multiple CRE infections were diagnosed at the
University of Virginia Medical Center. Within eight months, seven
patients had died.
Even with the medical expertise U.Va. could deploy, the outbreak
was a monster.
"When the doctors began analyzing the bacteria in their first
patient, who'd transferred from a hospital in Pennsylvania, they
found not one, but two different strains of CRE bacteria," USA Today
reported. "And as more patients turned up sick, lab tests showed
that some carried yet another."
That was the clue: The bacteria were acquiring new immunity even
as doctors tried to fight it. But rapid mutation isn't the only
barrier to fighting CRE, though it does make developing a drug
difficult and unprofitable.
The Centers for Disease Control and Prevention advises
traditional protocols for preventing CRE infection, including hand-
washing, isolation and gowns and gloves for everybody. Such
techniques have helped stem the spread of superbugs in some
facilities. Hospitals and other health care centers also need better
ways to screen for the germ.
Still, CRE is everywhere. It is constantly being re-introduced,
even in hospitals where it has been controlled. One hospital system
in the Bronx found 11 nursing homes - which rarely have the means to
test for CRE - that regularly sent infected patients to the
hospital.
But knowing such information, the newspaper reported, is the
exception rather than the rule. There's no federal reporting
requirement, so a national picture is difficult to decipher.
Anecdotes and local reporting show that CRE is widely distributed
and deadly.
Given CRE's potential for disruption - and death - a national way
to track the disease should be the emergency first step.
(C) 2013 The Virginian-Pilot and The Ledger-Star, Norfolk, VA. via ProQuest Information and Learning Company; All Rights Reserved