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Drug-resistant infection hits hospitals

By Candace Nelson

An emerging drug-resistant "superbug" is steadily increasing in hospitals across the country, according to the Centers for Disease Control and Prevention.

Carbapenem-resistant enterobacteriaceae, or CRE, is difficult to treat because it is resistant to almost all antibiotic treatments. It was first identified in the United States in 2001 and has been steadily increasing in the last decade.

"People haven't been taking the precautions necessary to prevent the prevalence of this type of infection, and that's why it's rising across the nation," said Dr. Rahul Gupta, health officer and executive director of the Kanawha-Charleston Health Department.

Healthy people usually do not get infected with CRE. CRE infections most commonly occur in people who are receiving treatment for other conditions. This particular bacteria most often affects people with underlying health conditions, who have been hospitalized for a long period of time or who live in a nursing home, according to Gupta.

Patients who use ventilators, urinary catheters, intravenous catheters or long courses of certain antibiotics are most at risk for CRE infections, according to the CDC.

CRE infections have high mortality rates, causing death in nearly 50 percent of people with serious infections, and the resistance can spread to other bacteria. At this time, CRE doesn't spread easily from person to person like other types of bacteria can, like the bacteria that causes pink eye or strep throat.

"CRE infections have been on our radar for several years in Kanawha County," said Janet Briscoe, director of the Division of Epidemiology at Kanawha Charleston Health Department. "Since early 2011, we've been working closely with the hospitals and nursing homes in our county to ensure that health care staffs are knowledgeable and trained to prevent CRE infections among their patients."

The health department's Division of Epidemiology had training for long-term care facilities in June 2011 and hosted a second training on the topic in August 2012 for infection prevention personnel from area hospitals and nursing homes.

Health care facilities and providers are not required to report CRE cases to local health departments, so it's difficult to obtain solid numbers about how many CRE infections are occurring locally or nationally. As cases continued to arise in Kanawha County, the health department is working with providers to prevent additional transmission of the bacteria, Briscoe said.

"We know that we have had the infections of this sort for several years now," Gupta said. "We have been trying to track, but at this time, West Virginia does not have a state law mandating the reporting of this killer bug."

According to the health department, prevention is important because treatment options are limited once a patient is infected. Patients and their families are encouraged to remind those entering a patient's room to wash their hands and also be wary of using antibiotics unnecessarily with common illness that will go away without antibiotic use.

The excessive use of antibiotics can increase a person's likelihood of developing a drug-resistant bacterial infection.

Once a person is infected with CRE, treatment options may include high dosages of antibiotics, mixtures of certain antibiotics or there may not be other available options for certain patients.

"Treatment options become complex - scary to dangerous because of the high levels of antibiotics, which can have toxic effects on the body and many more side effects," Gupta said. "This bug makes MRSA look like a walk in the park. We don't want to see this bug become a community-acquired bug and limit it to only the hospital so we can get a handle. If it becomes more transmissible, it's much more dangerous and difficult to control."

For more information, visit the CDC website at or the Kanawha Charleston Health Department at

Contact writer Candace Nelson at or 304-348-5148. Follow her at



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