The term "CRE" was barely a blip on most hospitals' radar before the Centers for Disease Control and Prevention highlighted the emerging infection, carbapenem-resistant enterobacteriaceae, in its "Vital Signs" report in March.
Of 3,918 acute care facilities performing surveillance for CRE, only 145 short-stay and 36 long-term hospitals had reported cases as of last June. But though the bug has been uncommon in hospital settings so far, four factors make it extremely worrisome, CDC experts say:
1. It kills half of patients whose bloodstreams become infected.
2. It is resistant to nearly all antibiotics.
3. It is increasingly seen in acute care settings.
4. It spreads quickly within and across healthcare settings through central line associated bloodstream or catheter associated urinary tract infections, especially in sicker patients. Surgery and dialysis seem to place patients at higher risk.
CRE was found in 1.2% hospitals in the country in 2001, but in 2011 and the first six months of 2012, it was in 4.6% of acute care hospitals. It is now in 18% of long-term care hospitals, and has been detected in hospitals in 42 states.
Six states: Tennessee, Oregon, Minnesota, Colorado, Wisconsin, and North Dakota, have made it reportable and others are considering it. So far, northeastern and southern states appear to have the most cases.
Now, the CDC is asking providers to be more diligent about looking for patients colonized with CRE, to segregate them and the healthcare personnel who care for them, not just from those without CRE, but from personnel who treat patients without CRE as well.