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Infection Control Crisis Carbapenem-Resistant Enterobacteriaceae

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Infection Control is critical as there is a dangerous new strain of antibiotic resistant bacteria that has been found in about 5% of US hospitals last year. The Center for Disease Control warns that this new superbug is Carbapenem-Resistant Enterobacteriaceae (CRE). It is a difficult infection to treat and has a high mortality rate. Most of the CRE cases involved Klebsiella species of bacteria. CRE infections are important because once these bacteria invade the blood stream, mortality rates are greater than 40%. Most of these infections start in the urine. CRE strains frequently have other antibiotic resistant capabilities that make them immune from most antibiotics and several strains resistant to all antibiotics have been detected. New antibiotics that might be effective against CRE strains are years away from commercial availability. Because Enterobacteriaceae are the most common infective CRE organism in the health care setting, with pseudomonas and acinebacter species being others, these bacteria have the potential for moving out of the hospital and into our communities.

Current strategies to control CRE start with contact precautions with anyone who is identified with the these strains of bacteria. Rectal cultures of patients at risk can identify patients who are harboring these superbug strains. Strict Infection Control measures are necessary to reduce CRE transmission. Physicians need to know which patients are colonized with them. Hand washing before patient contact remains critical. Specific rooms, equipment and staff should be set aside to care for these patients. Catheters and other temporary devices should be removed as soon as possible, and antibiotics should be prescribed carefully

Britcher Leone & Roth recognizes the need to both prevent infection and to timely treat it. Poor control measures allow these bacteria which threaten our antibiotic therapies' effectiveness to spread. Delayed diagnosis of infection can be catastrophic if the bacteria invade the blood stream. Multi-organ system failure and death can result.

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