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'Superbug' spreading to Southern California hospitals

2010 map of Carbapenem-Resistant Klebsiella pneumoniae in the U.S.

A dangerous drug-resistant bacterium has spread to patients in Southern California, according to a study by Los Angeles County public health officials.

More than 350 cases of carbapenem-resistant Klebsiella pneumoniae, or CRKP, have been reported at healthcare facilities in Los Angeles County, mostly among elderly patients at skilled-nursing and long-term care facilities, according to a study by Dr. Dawn Terashita, an epidemiologist with the Los Angeles County Department of Public Health.

It was not clear from the study how many of the infections proved fatal, but other studies in the U.S. and Israel have shown that about 40% of patients with the infection die. Tereshita was not available for comment Thursday morning but was scheduled to speak about the study in the afternoon.

"These are very serious infections, hugely complicated by the fact that the treatment options are severely limited," said Dr. Arjun Srinivasan, associate director for healthcare-associated infection-prevention programs at the federal Centers for Disease Control and Prevention in Atlanta.

The L.A. County Department of Public Health describes CRKP as an antibiotic-resistant organism that "can cause infections in healthcare settings, including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis."

The pathogen is even resistant to specialized drugs developed to treat difficult infections. "This is considered a threat to patient safety," according to the county, because such antibiotics "often are the last line of defense."

Unlike other superbugs such as methicillin-resistant Staphylococcus aureus, or MRSA, the CRKP pathogen is an enterobacterium, in the same "lethal family" of bacteria as E. coli, Srinivasan said.

"We've been monitoring the rise of this organism for a few years at CDC," he said. "Initially, it was first described in North Carolina, and then we started getting reports in the New York and New Jersey area. We are seeing reports of this organism all over the country now."

He stressed that unlike MRSA and other superbugs, CRKP has not spread in communities but remains confined to healthcare facilities.

"The key is that it remains pretty rare in most places," he said, although, "there are pockets of the country where they are encountering this a lot, like New York City."

The superbug is usually treated with the antibiotic colistin, which is so strong it is often toxic to patients but in other cases has not proved strong enough to overcome the bacterium, Srinivasan said.

The CDC recommends an aggressive approach in preventing the spread of the bacterium, including isolating infected patients and testing those around them.

Prevention is key, Srinivasan said, including ensuring regular hand washing by healthcare workers and other basic infection-control measures.

Tereshita analyzed the results of patient tests the health department required hospitals and labs to submit June 1, 2010, to Dec. 31, 2010. Reports were filed by 102 hospitals and five labs.

Of the infections reported, 146 (42%) occurred at eight long-term acute-care hospitals, one of which had an outbreak.

An additional 20 cases were reported at skilled-nursing facilities.

The rest were reported at acute-care hospitals. Particular facilities were not identified in the report.

The mean age of patients who tested positive for the pathogen was 73, and more than half were female, the study showed.

Terashita concluded that CRKP was more common in Los Angeles County than public health officials had thought (possibly because cases had not been reported accurately), that hospitals need to do a better job of reporting infections and that healthcare facilities need to raise awareness about the bug to prevent the spread of infection.

"These patients tend to travel frequently between these and other healthcare facilities," she wrote.

Terashita's study had been embargoed for release at a conference of the Society for Healthcare Epidemiology of America in Dallas, beginning on April 1, but several news organizations decided to publish the results Thursday, citing the "public health concerns involved."

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Map: States colored yellow show confirmed CRE cases caused by the KPC enzyme in 2010. A blue dot represents a confirmation of NRE caused by NDM-1 enzyme. An orange dot represents a CRE caused by a VIM or IMP enzyme. Credit: CDC

 
Comments () | Archives (23)

Okay, I'm reading this in a Skilled Nursing Facility, where I'm recuperating from a hip replacement operation. So, how do I find out which facilities have an outbreak of this infection? This is a public health issue and can't be a cause to hide the places where an outbreak has occurred.

Selfish on my part? You bet.

If it is preventable, why is it spreading? Teach the health care workers that are taking care of mom and dad, how to wash their hands. Demand they do it!

Nice of big pharma to spend all that money on marketing Viagra and buying doctors but little on new antibiotics...

I just ate three bags of Fritos.

This report doesn't say where or which Facilities have been effected. We need to know that!

This has been in the UK media for quite a while.

Apparently originated in India, as a result of back-street medical 'services' doling out antibiotics. Spread to Europe via Europeans having 'inexpensive' elective surgeries in India.

To think the Republicans are calling to drastically cut CDC funding.

Imagine that.

Hey Southern Californians,

Between the passage of laws like marijuana, erotic massage parlors, and who knows any number of other disturbing trends, if articles like this one make citizens of the area wonder if maybe your health is in jeopardy.

Colloidal silver inhaled via a nebulizer will stop all viruses and bacteria in the lungs.

This is Obamacare in action !!!

"Nice of big pharma to spend all that money on marketing Viagra and buying doctors but little on new antibiotics...

Posted by: affableman | March 24, 2011 at 10:49 AM"

^^^^ FAIL!

These superbugs exist BECAUSE of antibiotics. The use/overuse/misuse/abuse of antibiotics has allowed germs to evolve and develop resistance to each new antibiotic drug that has been introduced to fight it...

There has to be a better answer.

It's no surprise to someone who observed a pathetic facility last year, in Orange County, in Lake Forest, near El Toro and Trabuco! My Mom and I went thru 24 hours of worry. The facility left my Mom in a gurney for hours before sending her to a room with a terminally ill patient who was transported hours later. They failed to provide medication. The staff ignored requests for the same medication that she had had at a REAL hospital following major surgery for 3 days. What was supposed to be 2 weeks therapy ended in 24 hours when I got her home. NEVER again will I allow my Mom to be sent to an assisted nursing facility. California is wiping palms with these greasy "hospitals". Why isn't the U.S. Health & Human Services shutting them down, or at least threatening them with a shutdown?

She had her cellphone, thank god. I told her the next morning they would try to keep her from leaving. As soon as our conversation ended, half of dozen staff stuck their faces in the door and did just as I said they would. They didn't give a damn until someone began complaining. How can anyone send their parents to these places? Would they send sick children to such a place?

Mash6268 - You might want to talk to the people in North Carolina as well, since it seems that is where it was first reported in the US. Not sure where you're from, but California can't be blamed for everything.

I have become alarmed in recent years at how these infections have spread. I have read up and now realize that hospitals and other facilities are NOT taking proper sanitary precautions -- and I am very surprised class action suits have not been filed.

The typical for doctors and staffers is to possibly use the disinfectant ointment you commonly find in dispensers on the walls at such facilities. But that ointment is alcohol based, and many of these most potent bugs are not affected by alcohol. MRSA requires at least washing with soap and hot water. Another, C-Diff, which led to my father's death and nearly killed my mother, isn't even affected by soap and hot water, requires bleach.

These bugs are in everything at the facilities: the blankets on the beds, the tables, the doctors and nurses uniforms, the tables at the cafeteria. They are picked up and spread all over. Hospitals have NOT stepped up their sanitation to control this! They are NOT necessarily requiring all uniforms -- or any other clothes worn by staff -- to be washed in bleach. They are NOT providing any wipe down of tables, bed frames, door knobs, sinks or other by bleach solutions. They are NOT requiring doctors and staff to even so much as wash their hands in soap and hot water, just settle for the ineffective alcohol solution!

I find this incredibly negligent! Please, the word must get out that they must make widespread use of bleach solutions all over these facilities. Also, any visitor would do good to bring along some bleach wipes form the store and wipe down everything for the patient when they are visiting.

We need legal requirements that all such facilities make widespread use of bleach solutions all over and for everything -- because they are NOT doing it on their own.

Pure BIO has foreseen this problem and developed SDC which kills these superbugs (and superbugs are unable to develp a resistance to SDC). Maybe too late because folks are slow to change.

"He stressed that unlike MRSA and other superbugs, CRKP has not spread in communities but remains confined to healthcare facilities."
"The key is that it remains pretty rare in most places," he said, although, "there are pockets of the country where they are encountering this a lot, like New York City."

MRSA was once only confined to health care facilities and 'rare' too.... but hospitals unleashed a MRSA epidemic by not doing enough to prevent the spread. Since hospitals use CDC guidelines like a guideline 'bible', one would think that the CDC would elevate prevention methods for both MRSA and these other superbugs (make screening and isolation a level one requirement instead of level II).

MRSA started in hospitals in the 1960's. By 2000, it was spreading in communities like wildfire (patients carry it home from the hospital, home-health workers go from home to home carrying it with them). It's becoming more and more obvious that if the CDC doesn't direct hospitals and outpatient surgery centers to ramp up prevention efforts universally with their level I guidelines, then the same will happen with these other deadly infections.

It's time to start a 'search and destroy' approach to these deadly, costly infections. Universal pre-screening, patient isolation, handwashing, patient hygiene, environmental cleaning and other known methods of prevention need to be mandated. Such simple steps but they elude us because there's such little oversight and accountability for hospital administrators to follow through on them.

If you would like a glimpse of what's truly happening on the front line in hospitals, read this:
http://patientsafetyadvocate.blogspot.com/2011/03/hospital-stay-infection-history.html

Preventable? Yeah, maybe 50 years ago before we started passing out antibiotics like candy and dumping millions of tons per year into animal feed.
Now we're stuck with it.

Amazing how Israel is always involved in research on any new bacteria, virus, food disease, etc.

They were researching honeybee collapse syndrome before it even started happening!

Amazing!

This is a great article and we thoroughly enjoyed listening this morning. We are passionate about cleaning and hand washing to prevent cross infection.

To date, I hardly see any mention of taking a powerful probiotic.....and especially not the ones with FOS, which can encourage good AND bad bacteria...primarily Klebsiella ( which by the way, is a yeast infection)

As a retired long term nurse, my question is why have they been "watching" this disease for 2 years at the CDC? Why not stop the spread.

The superbug may be an area of concern. But I think there are more pressing problems than this. Like AIDS. HIV can infect everybody who's sexually active. CRKP seems to infect only the immunocompromised. I hope we discern well since the media seems to be doing a good job of at least informing the world of this situation.

Some clinical studies demonstrate that the nutritional supplement, colloidal silver, which has some pretty interesting antimicrobial qualities, is also very effective against MRSA. See www.ColloidalSilverCuresMRSA.com


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