HLM: Can you give some background? The CDC website says that CRE was "uncommon" before 2000. What happened recently that you think has provoked transmission?
AS: That's a really good question for which we don't have a satisfying answer. We really don't know why CRE, or any bacteria for that reason, all of a sudden emerges and spreads and resistance develops quickly. The first isolate was described here at the CDC in 2001 from a single isolate in North Carolina. We heard about sporadic outbreaks in hospitals in the 2000s, and in 2009, we issued our first guidance for preventing transmission. We revised the guidelines, primarily for public health departments, in 2012. The Vital Signs issue in March is an effort to raise awareness.
HLM: Can you be more specific?
AS: There are recommendations targeted for health departments to prevent the spread by working across facility types and the continuum of care. We think public health departments can play a very important role in helping ensure better coordination and communication between healthcare facilities. The 2009 and 2012 recommendations are fundamentally the same, there's just more context.
HLM: What other messages would you like to convey to infection control teams?
AS: Antibiotic stewardship is the other big area where we have not done all we need to. We know antibiotics are overused both in hospitals and outpatient settings, and we know that's one of the factors contributing to resistance, including CRE. Most importantly, it's the factor we can control. We can't control how organisms develop resistance, but we can control how we use antibiotics.