It’s not often that you get to hear a top federal health official deliberately deploy a headline-grabbing word such as “nightmare,” or warn: “We have a very serious problem, and we need to sound an alarm.”
Dr. Thomas Frieden, director of the US Centers for Disease Control and Prevention, said both Tuesday, during a press conference announcing new CDC statistics on the advance of the highly drug-resistant bacteria known as CRE.
His language — plus that fact that he conducted the entire press conference himself, instead of just making a brief opening statement — seem to me a clear signal that the CDC is taking this resistance problem seriously, and hoping we do too.
And we should. Here’s what the CDC announced Tuesday:
• Healthcare institutions in 42 states have now identified at least one case of CRE.
• The occurrence of this resistance in the overall family of bacteria has risen at least four-fold over 10 years.
• In the CDC’s surveillance networks, 4.6 percent of hospitals and 17.8 percent of long-term care facilities diagnosed this bug in the first half of 2012.
Those are dire reports.
Here’s some back-story: CRE stands for “carbapenem-resistant Enterobacteriaceae.” Enterobacteriaceae are a family of more than 70 bacteria which share the characteristic of being gut-dwelling (“entero”); they include Klebsiella, Salmonella, Shigella and E. coli.
Carbapenems are a “last-resort” family of antibiotics — imipenem, meropenem, doripenem and ertapenem — which are used against these bacteria when they have become resistant to other drugs. (Carbapenem resistance is conferred by a number of different genes and so sometimes goes by a number of other acronyms, including KPC, VIM, OXA and the “Indian superbug” NDM-1.)
CRE tends to attack in ICUs and other critical care, and also in rehab units and nursing homes. That is for several reasons. First, because patients in those settings are uniquely vulnerable to infection, not just because of their illness but because the protective barrier of their skin has been breached by ports and catheters, and also because they are visited and touched by a lot of people.
Second, because they are likely to be receiving heavy-duty antibiotics which put the bacteria in their bodies under evolutionary pressure.
Third, because those drugs plus others cause diarrhea, which spreads gut-dwelling bacteria into the air and area.
And fourth, because those bacteria are particularly good at surviving on the kind of surfaces — plastic, glass and metal — that you find in health care.