Author – Arjun Srinivasan, MD
CDC’s Division of Healthcare Quality Promotion
You probably have seen the media reports this week about drug-resistant infections in California healthcare facilities, specifically those in Los Angeles County. What we know, however, is that carbapenem-resistant Klebsiella pneumoniae (CRKP) actually exists in at least 36 states. Originally identified in 1999, CRKP may be present in the other 14 states as well, just not yet reported to CDC.
CRKP is a Gram-negative bacteria and part of a family called Enterobacteriaceae. Carbapenem-resistant Enterobacteriaceae (or CRE) are able to fight off our last-resort antibiotics and have become an important public health issue resulting in high mortality (death) in patients.
How can we stop these bugs? CDC released prevention guidelines on multi-drug resistant organisms in 2006 and guidelines specifically targeting CRE in 2009. [See my previous blog posts on how to prevent CRE.]
Here is the bottom line – first, now is the time to act! We have prevention recommendations – they just need to be enacted. We must tackle these bugs before they become endemic (widespread). Secondly, the Los Angeles County experience demonstrates the important role that state and local health departments are playing in monitoring and prevent healthcare-associated infections. Lastly, tracking infections is key. These findings demonstrate the vital need to continue to monitor drug-resistant bacteria. If we want to stop resistant bacteria in their tracks, we have to know where to begin and how we are doing.
The recent media reports are based on a scientific abstract being presented at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA) this week. Later this week, we will feature more science coming out of the SHEA conference. In the meantime, here is the recent press release about CRKP:
Drug-resistant pathogen found in large numbers in LA County
Study findings highlight need for heightened surveillance
Arlington, Va. (March 24, 2011) – Researchers with the Los Angeles County Department of Public Health have found high rates of the multi-drug resistant pathogen, carbapenem-resistant Klebsiella pneumoniae (CRKP) among the patient population in long-term acute care hospitals compared to general acute care hospitals across the county. These findings are particularly important because CRKP was thought to be contained to East Coast facilities and communities. These findings will be presented at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA) on April 3 in Dallas.
CRKP is resistant to nearly all antibiotic options and has been associated with higher mortality, longer hospital stays and increased health care costs. Because CRKP was thought to be rare in Los Angeles County, though actual numbers were unknown, Dawn Terashita, MD, MPH, Medical Epidemiologist and colleagues, with the county’s Department of Public Health sought to establish a surveillance system to monitor its existence in the county.
After declaring CRKP a laboratory-reportable disease, meaning that its appearance must be reported by a laboratory if found during testing, Terashita’s team noted unexpectedly high numbers of CRKP across the county. During the study period of June 2010 to December 2010, 350 cases of CRKP were identified. Many of the cases, 42 percent, occurred in long-term acute care hospitals, and 6 percent were found in patients residing in skilled nursing facilities. [Read more…]