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Drug-resistant 'superbug' mostly limited to Southern California nursing homes, health officials say

March 24, 2011 |  1:57 pm

A drug-resistant bacterium that has surfaced in Southern California has mostly spread in nursing homes, not hospitals, but more needs to be done to track it, health officials said Thursday.

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.

"They've been brought into the hospital from the nursing home," said Dr. Brad Spellberg, an infectious-disease expert at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center near Torrance. "There's no evidence that this organism is being spread person to person in hospitals."

A spokeswoman for the Sacramento-based California Assn. of Healthcare Facilities, which represents more than 1,200 nursing homes, disagreed.

“There’s no evidence this is being spread person to person in nursing homes,” said spokeswoman Deborah Pacyna. “If this was a problem, we would have heard about it.”

At least five patients at Torrance Memorial Medical Center developed CRKP infections during the last year after being transferred to the hospital from nursing homes where they had become infected, said Elizabeth Clark, director of infection control at the hospital.

Once the infections were detected at the hospital, the patients were isolated in private rooms with added safety precautions, Clark said. None of them died or passed on the infection to others, she said.

Clark said CRKP is only one of the drug-resistant infections she battles at the hospital, but that, "it's a concern because of the difficulty of treating someone."

It was not clear from the study how many of the infections reported locally proved fatal, but other studies in the U.S. and Israel have shown that about 40% of patients with CRPK die.

Tereshita was not available for comment but was scheduled to talk about the study at 4 p.m. Thursday with Dr. Jonathan E. Fielding, the county's public health chief.

Tereshita analyzed the results of patient tests the health department required hospitals and labs to report from 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 remainder were reported at acute-care hospitals. Facilities were not identified in the report.

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

Terashita concluded that CRKP was more common in L.A. County than public health officials had thought, possibly because cases had not been reported accurately.

She also concluded that hospitals need to do a better job of reporting infections and that healthcare facilities need to raise awareness about the bug to prevent its spread because "these patients tend to travel frequently between these and other healthcare facilities."

Unlike other superbugs such as Methicillin-resistant Staphylococcus aureus, or MRSA, the CRKP pathogen is an enterobacteria, in the same family of bacteria as E. coli.

"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.

He said the CDC has been monitoring the spread of CRKP for years, but federal officials have not required local reporting of suspected cases.

Some of the first cases were reported in North Carolina in 1999, then later in New York and New Jersey.

Now, Srinivasan said, "we are seeing reports of this organism all over the country."

He stressed that unlike MRSA and other superbugs, CRKP has not spread beyond healthcare facilities.

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

CRKP is usually treated with the antibiotic colistin, which can cause kidney damage and in some cases still fails to penetrate the "gram negative" bacteria's protective membrane.

Jim Lott, executive vice president of the Hospital Assn. of Southern California, said hospitals have contained similar drug-resistant bacteria and he was not concerned CRKP could spread within or outside health care facilities.

But patient advocates said they wanted assurances that hospital officials will do more to stop the spread of CRKP and other virulent bacteria.

“You want to be sure there is a strategy in place to contain it so it doesn’t get into the community,” said Lisa McGiffert, manager of the Austin, Texas-based Safe Patient Project at Consumers Union, the nonprofit that publishes Consumer Reports. “That’s going to take some serious changes in hospitals—strict isolation procedures and hand hygiene. We don’t have any confidence that that is happening.”

-- Molly Hennessy-Fiske