“Superbugs” have been in the news a lot lately — for good reason. The recent interest in these was triggered by two important national reports that came out documenting the surge in these highly antibiotic-resistant bacteria over the last decade.
One of these reports was from the Centers for Disease Control and Prevention. These bacteria are often termed “CRE,” which is short for Carbepenem Resistant Enterobacteriaceae. These are versions of common bacteria such as E. coli that have mutated to survive in the presence of even our strongest antibiotics.
The Infectious Disease Society of America has been sounding the alarm on this situation for a few years now, calling this problem a “national public health emergency.” Infectious disease specialists and others are also concerned about the tremendous lack of new antibiotics coming to market at the same time we are struggling to treat these infections.
In the United States, these bacteria have spread east to west, so New York has had a much bigger problem with these so far than has San Francisco, but they are popping up on the West Coast more often now. According to the CDC, 92 percent of these infections occur in people with significant other medical illnesses who spend more time in nursing homes, hospitals and other health-care facilities. They cause problems such as blood stream infections, pneumonias, urinary tract infections and abdominal infections.
At Cottage Health System, we anticipated the arrival of these pathogens several years ago and had our lab set up screening tests to monitor for these bacteria so we could address them promptly when they did show up here. Well in advance of their arrival, we strengthened our policies requiring extra infection prevention precautions (gowning and gloving) for patients carrying these bacteria, so staff would not inadvertently carry these bacteria from one patient to another.
As expected, the few cases of these bacteria seen at Cottage have generally arrived in patients transferred here from bigger cities. Patients are often transferred to Cottage for its care expertise.
Our rates of CREs and other drug-resistant bacteria are very low, so patients can feel confident their chances of catching these infections (and other health-care associated infections) at Cottage are exceptionally low.
Nationally, the prevalence of these CRE bacteria is estimated at 4.2 percent by the CDC, which means that 4.2 percent of the time E coli-like bacteria are detected in the United States they are the resistant type. That number represents a major increase from a decade ago, which is the reason for the national “superbug” concern. At Cottage, our rate is much less than 0.5 percent, and we are proud of that. Our rates of drug-resistant infections and health-care associated infections are published online at www.cottagehealthsystem.org.
What else is Cottage doing to prevent and control these “superbugs”? Hand-washing plays a key role in preventing the spread of these bacteria, and our rates of hand-washing by staff far exceed national benchmarks. Since superbugs are created by our society’s overuse of antibiotics, reducing inappropriate antibiotic use is important.
Last year, Cottage launched an Antibiotic Stewardship Program aimed at reducing antibiotic use in the health system. The program is staffed by pharmacists with special training and infectious disease physicians who work with our physician-colleagues to refine antibiotic prescription. Since the program’s launch, we have already documented significant reductions in antibiotic use in our institution.
Education of health-care workers in our community about drug-resistant infections is emphasized by our Infection Prevention and Control Department, and Cottage believes that educating the community about these organisms is an important issue.
Fighting infections is a never-ending battle. Cottage Health System’s mission is to achieve and maintain a zero rate of hospital-acquired infections. It is an ambitious goal, but one we are deeply committed to achieving.
— David Fisk, M.D., is medical director of infection prevention and control and co-medical director of antibiotic stewardship for Cottage Health System, and infectious disease physician for the Sansum Clinic.