Researchers announced last week that they found unexpectedly high rates of a multidrug-resistant pathogen in patients in long-term acute care hospitals in Los Angeles County. Bacteria with the same proteins as the pathogen have been found on the South Coast, and infectious disease specialists are cautioning the public about overuse of antibiotics.
The pathogen found in Los Angeles — carbapenem-resistant Klebsiella pneumoniae, or CRKP — was previously thought to be contained to the East Coast.
“CRKP is resistant to nearly all antibiotic options and has been associated with higher mortality, longer hospital stays and increased health-care costs,” according to a news release issued by the Society of Healthcare Epidemiology of America.
Dr. Dawn Terashita, an epidemiologist with the Los Angeles County Department of Public Health, and her team discovered 350 cases across the county in the course of six months.
The L.A. study didn’t go as far as to say how the bacteria got there, whether by improper care or other means. But “these patients tend to be elderly, they are commonly on ventilators and they often stay at the facility for an extended period of time,” Dr. Terashita said in a statement. “They tend to have many health problems and are often placed on antibiotics which may or may not be appropriate.”
All are factors that would contribute to a greater risk of health-care-acquired infections.
Locally, Dr. David Fisk with the Sansum Clinic’s Infectious Disease Department and director of Infection Prevention and Control for Santa Barbara Cottage Hospital told Noozhawk they had isolated bacteria with the same proteins as CRKP bacteria, but they’ve seen them only in their laboratory — a common lab that both Cottage and Sansum share, as well as other doctors.
So he said he can’t localize the bacteria, other than saying it’s from the Central Coast.
The CRKP bacteria is part of a larger spectrum of bacteria called gram negative bacteria, and there are many different mechanisms by which they become resistant to antibiotics.
Fisk said he fully agrees that “these are big threats.” He said he’s seeing many proteins that have high levels of antibiotic resistance in Santa Barbara, and the lab has identified in a handful of their lab cultures, but that there hasn’t been any clinical illness from these strains.
“Sometimes the lab identifies them, but they’re not linked to a problem,” he said, adding that the bacteria isn’t something that requires treatment. “You can be colonized with the bacteria but not infected with it.”
Though it’s unknown how many patients in Southern California have died from infections of CRKP bacteria, they are are associated with high mortality rates.
“When you see those rates, you have to keep in mind that many of these infections occur in pre-existing illness,” Fisk said.
He said doctors will also see higher mortality rates early on in an epidemic. “Over time, we tend to find cases that aren’t lethal,” he said.
Fisk said people who have come in to the Sansum Clinic with common infections, such as urinary tract infections, sometimes need to have antibiotics administered intravenously, instead of orally. Those gram negative bacteria are becoming more resistant as a whole, he said.
In terms of prevention, he said patients should work with their physicians to see if antibiotics are really needed.
“Fifty percent of the time, they are over-prescribed or inappropriately prescribed,” he said. “We have to change how we use them.”
Dr. Takashi Wada, director of the Santa Barbara County Public Health Department, said there’s no mandatory reporting of CRKP cases to the county. he said staff are still researching the issue, but that he wasn’t aware of any outbreaks of CRKP within the county.
Medical facilities, such as Cottage Hospital, have programs to monitor the presence of bacteria and how antibiotics are used internally.
Leslie Stanfield, director of Infection Prevention and Control at Cottage Hospital, said that when dealing with multidrug-resistant organisms, surveillance is key.
Several hospital departments, including the pharmacy, work with Infection Prevention and Control. An antibiogram is sent out every year to Cottage physicians, which “allows the physician to pick the best possible antibiotic for the organism in this community,” she said.
The hospital also has an electronic system set up that alerts Infection Prevention and Control if a patient comes in with a positive culture to the multidrug-resistant organisms, “so we can get them into isolation immediately,” Stanfield said.
She said hand hygiene is important for the community as well as health-care workers.
Cottage Hospital specifically has seen some of the drug-resistant Klebsiella bacteria, but not the CRKP, she said. People who are hospitalized for a long period of time, who have invasive devices and who are critically ill are more prone to these types of organisms, she said.
“Right now, we have a lot of focus in the OR picking the correct antibiotics,” she said, adding that the staff is working to expand that oversight systemwide.