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Understanding and combating CRE bacteria in Chicago

Categories: Antimicrobial Resistance

Michael Lin, MD, MPH

Michael Lin, MD, MPH

Guest Authors - Michael Y. Lin, MD MPH and
Mary K. Hayden, MD

Rush University Medical Center
CDC, Chicago Antimicrobial Resistance and Infection Prevention Epicenter

Increasingly, certain kinds of bacteria are causing serious infections that are difficult or impossible to cure because the bacteria are resistant to all or nearly all antibiotics. Carbapenem-resistant Enterobacteriaceae, or CRE, are one of the most feared group of these extremely drug-resistant bacteria; they are spreading worldwide, with few treatment options.

CRE are not equal opportunity bacteria; rather, they typically affect the sickest patients. These patients are cared for at a whole range of inter-connected healthcare facilities, from traditional hospitals to long-term care facilities.

In Chicago, CRE were not known to exist prior to 2007. When an increase in healthcare-associated CRE was detected in 2010, we partnered with CDC to develop a plan to combat CRE infections in our region.

Many questions exist regarding how to best control CRE, especially when it affects a whole region of healthcare facilities. The CDC, via its Prevention Epicenters program, has supported coordination of effort between local scientists such as ourselves and public health officials to try to understand how to best prevent the spread of CRE in Chicago so that lessons can be applied to other areas confronting CRE.

Through support from CDC, we are studying control strategies that fight the spread of CRE in facilities that care for the most vulnerable of our patients. Such control programs include region-wide efforts that combine proven strategies for infection control, such as (1) actively identifying and providing special precautions for patients who carry CRE, (2) improving healthcare worker hygiene practices, and (3) improving patient skin hygiene and applying a protective antiseptic. We will be analyzing the results of the program in late 2013.

In order to monitor the regional effects of the program, we are improving surveillance of CRE through active search strategies, such as periodically checking patients in Chicago intensive care units for CRE. We are also harnessing the power of communication, by growing public health information systems to promote timely sharing of infection control information between healthcare facilities.

In Chicago, we see a tremendous spirit of cooperation among healthcare facilities that is necessary to combat the common CRE threat.

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