Categories: Antimicrobial Resistance, Gram negatives, HICPAC, Healthcare-associated infections, Long Term Care (LTC)
March 29th, 2011 3:18 pm ET -
Arjun Srinivasan, MD
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.]
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Categories: Antimicrobial Resistance, BSIs, CLABSI, Gram negatives, Healthcare-associated infections, Hemodialysis, MRSA, NHSN
March 2nd, 2011 4:07 pm ET -
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Arjun Srinivasan, MD
Author – Arjun Srinivasan, MD
CDC’s Division of Healthcare Quality Promotion
As you know, bloodstream infections in patients with central lines can be deadly, killing as many as 1 in 4 patients who gets them. The newest edition of the CDC Vital Signs reports a major decrease in central-line associated bloodstream infections (CLABSIs) in intensive care unit (ICU) patients. This is an important triumph for patient safety and brings me a renewed sense of hope toward the elimination of HAIs. It also solidifies an expectation that infection prevention should be a priority in order to improve the safety of patients.
While progress is promising, about 60,000 bloodstream infections in patients with central lines still occurred outside of ICUs and in dialysis centers, according to our report. Much of this is preventable harm. We have to make every effort to ensure patients are protected in all healthcare facilities, all the time. So, how do we do that?
The good news is that everyone can contribute to preventing CLABSIs, no matter where the patient receives care.
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Categories: Antibiotic use, Clostridium difficile, Gram negatives, Healthcare-associated infections
November 16th, 2010 3:44 pm ET -
Arjun Srinivasan MD
Author - Arjun Srinivasan, MD
CDC – Medical Director, Get Smart for Healthcare Program
Over the past 2 years, I have brought together experts on antibiotic resistance to discuss how CDC can assist in efforts to improve antibiotic use in hospitals and nursing homes. My colleagues have published numerous studies demonstrating that inappropriate antibiotic use in hospitals and nursing homes results in increased resistance, worse patient outcomes, and increased costs. It is also helping drive the national epidemic of Clostridium difficile infections. This year, we have watched as deadly new mechanisms of antibiotic resistance were discovered in U.S. hospitals, mechanisms that will undoubtedly challenge our healthcare system and affect patient safety (see NDM-1, VIM). Clearly, we have a serious problem.
Those initial discussions with colleagues resulted in an expansion of CDC’s Get Smart programs, which target antibiotic use in outpatient clinics and pediatrician’s offices, to include a comprehensive program targeting inpatient settings. This week, CDC launched the Get Smart for Healthcare program aimed reducing inappropriate antibiotic use in hospitals and nursing homes. The foundation of this program is the concept that everyone plays a role in improving antibiotic use.
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Categories: Antibiotic use, Gram negatives, Healthcare-associated infections
September 22nd, 2010 5:52 am ET -
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Alexander J. Kallen, MD, MPH
Author – Alexander Kallen, MD, MPH
Medical Officer
CDC’s Division of Healthcare Quality Promotion
Last week my colleague Dr. Brandi Limbago addressed the issue of carbapenem-resistant Enterobacteriaceae (CRE) and specifically enzymes called KPCs and NDM-1s that are causing the bacteria to become resistant to last-resort antibiotics. Today, CDC released a report about another enzyme causing CRE. This one is called VIM (Verona integron-encoded metallo-beta-lactamase). VIM has been found previously in a number of countries including Greece where this patient had been transferred from. View recommendations for surveillance and prevention here.
Just as Dr. Limbago mentioned last week, these enzymes are new routes to the same destination: CRE. All types of CRE are significant and emerging public health problems, regardless of their route to resistance or their country of origin. The fact is that we live in a very small world, medically speaking, and it’s not surprising that these organisms are moving from country to country. This situation simply reinforces the need for better antibiotic stewardship, transmission prevention and overall healthcare-associated infection (HAI) prevention in every hospital and practice – today.
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Categories: Antimicrobial Resistance, Gram negatives, Healthcare-associated infections
September 17th, 2010 3:24 pm ET -
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Brandi Limbago, PhD
Author – Brandi Limbago, PhD
CDC’s Division of Healthcare Quality Promotion
You’ve likely seen the news over the last couple of weeks warning people about “The [so-called] New Superbug NDM-1,” a newly discovered gene that makes bacteria resistant to last-resort antibiotics called beta-lactams or carbapenems. NDM stands for New Delhi Metallo-beta-lactamase, and in this case the NDM gene rendered antibiotics useless in three cases of infection with carbapenem-resistant Enterobacteriaceae (CRE). CDC discovered NDM-1 in the United States this year and reported it through the MMWR in June. Is it concerning? Absolutely; and we are working closely with healthcare providers and health departments to stop transmission of these bacteria.
That said, I’d like to point out that the story shouldn’t be solely about these bacteria being new or imported from other countries; the story should be about the whole group of CRE and untreatable infections they cause. In reality, these are not the first CRE cases we’ve seen in the United States. Not even close. NDM-1 is actually just one type of CRE and represents a larger antibiotic resistance issue that we already have, right now, in this country. CDC has been working with partners to prevent a type of CRE known as KPCs (carbapenemase-producing Klebsiella pneumonia). The KPC gene also makes Enterobacteriaceae bacteria resistant to beta-lactam/carbapenem antibiotics, just in a different way than NDM-1. KPCs have been reported in about 35 states and are associated with high mortality – 40 percent in one report. It may be in the other 15 states as well, but has not been reported to CDC. So, let’s not wait for NDM-1 in order to take action.
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