Washington, D.C. -- A new study in the journal Infection Control and Hospital Epidemiology reports a dangerous rise in drug-resistant strains ofKlebsiella pneumoniae bacteria. Infections caused by these bacteria are already a threat to patient safety and are increasingly common in healthcare facilities throughout the U.S. The study, comprising the largest national analysis of carbapenem-resistant Klebsiella pneumoniae(CRKP) and related resistant organisms, is published online today and will appear in the journal’s March print edition.
Infections with CRKP bacteria, broadly classified as carbapenem-resistant Enterobacteriaceae (CRE), strike critically ill patients in hospital intensive care units (ICUs) and long-term care facilities, and can be fatal in up to 40% of cases. CRE made national headlines following a 2011outbreak
that killed 11 patients at the National Institutes of Health’s Clinical Center. Last month, an analysis
of 2010-2011 data collected by local health authorities revealed the bacteria has become endemic in facilities across Los Angeles County.
Using data from close to 300 laboratories that serve hospitals, clinics, and nursing homes across the country, researchers at the Extending the Cure project analyzed trends in resistance to cephalosporins and carbapenems, antibiotics usually reserved to treat the sickest patients.
The study found that, in 2010, 4.5% of Klebsiella pneumoniae bacteria isolated from patients were resistant to carbapenems (CRKP), as compared with less than 0.1% in 2002. The problem has spread nationally after initial outbreaks in New York and the surrounding Mid-Atlantic states in the mid-2000s. Between 1999 and 2010, samples that showed resistance to cephalosporins – and could therefore only be treated with carbapenems – more than doubled, going from 5.3% to 11.6%. Resistance was most prevalent in ICUs and nursing homes, but was also emerging among outpatients.
“The findings are alarming because these outbreaks are extremely difficult to control and carry a high mortality risk,” said Ramanan Laxminarayan, director of Extending the Cure, a project examining antibiotic resistance at the Washington, D.C.-based Center for Disease Dynamics, Economics & Policy. “We could be on the verge of a epidemic similar to the one we have seen with methicillin-resistant Staph aureus or MRSA-like, if these bacteria become common in the community. Except there are far fewer backup treatments for CRKP than we had for MRSA.” Extending the Cure is supported by the Robert Wood Johnson Foundation’s Pioneer Portfolio, which funds innovative ideas that may lead to breakthroughs in the future of health and health care.
To address the growing threat of multidrug-resistant infections, public health authorities need to adopt surveillance and control measures that span multiple levels of the health system, the researchers said. For example, we should assure that facilities, including long-term care hospitals and nursing homes, have the capability to detect and report CREs before they spread to other institutions along the continuum of care. In addition, we need more research on effective infection control strategies, and incentive mechanisms to speed up the lagging pace of drug development, according to authors.
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About Extending the Cure
Extending the Cure is a research effort that examines policy solutions to address the growing problem of antibiotic resistance. The project is based at the Center for Disease Dynamics, Economics & Policy (CDDEP) in Washington, DC. To find out more, go to www.extendingthecure.org.
About the Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful, and timely change. For 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Follow the Foundation on Twitter or Facebook.