Klebsiella pneumoniae, seen here with an electron microscope, are the most common superbugs causing highly drug-resistant infections in hospitals.
Federal officials warned Tuesday that an especially dangerous group of superbugs has become a significant health problem in hospitals throughout the United States.
These germs, known as carbapenem-resistant Enterobacteriaceae, or CRE, have become much more common in the last decade, according to the Centers for Disease Control and Prevention. And the risk they pose to health is becoming evident.
"What's called CRE are nightmare bacteria," Dr. Thomas Frieden, director of the CDC, tells Shots. "They're basically a triple threat."
First of all, they are resistant to virtually all antibiotics, including the ones doctors use as a last-ditch option.
Second, these bugs can transfer their invincibility to other bacteria. "The mechanism of resistance to antibiotics not only works for one bacteria, but can be spread to others," Frieden says.
Third, the bacteria can be deadly. Infection with the bacteria "have a fatality rate as high as 50 percent," Frieden says.
Although the resistant bacteria potentially pose a risk to anyone, people whose immune systems are weaker, such as elderly people, children and people who have other health problems, tend to be most susceptible to infection.
If the drug-resistance starts to spread from bacteria that are usually a problem in hospitals to much more widespread causes of infections, the risk could rise even more. "If it spread to things like E. coli, which is a common urinary tract infection, it would be a very serious problem," Frieden says.
The CDC sounded the alarm because of data that show the proportion of bacteria that have this resistance to many drugs has quadrupled in the last decade or so.
CRE cases were reported by 4 percent of hospitals in 2012, up from about 1 percent from about a decade earlier, according to the report. In long-term care hospitals the situation is even worse — about 18 percent have reported cases, the CDC says.
In addition, the proportion of Enterobacteriaceae bacteria that were resistant increased from 1.2 percent in 2001 to 4.2 percent in 2011, the CDC reported.
"And that's for the whole family." says Dr. Arjun Srinivasan, the CDC's associate director for health care-associated infection-prevention programs. "When we look at one member of this family, a bacteria called Klebsiella, which is the most common type of CRE that we see in the United States, resistance there has gone from about 2 percent to over 10 percent. So a dramatic increase in the frequency with which these organisms are being seen in our hospitals in the United States."
Infectious disease specialist Dr. Brad Spellberg, of the Los Angeles Biomedical Research Institute at the Harbor-UCLA Medical Center, likens the situation to the Titanic's ill-fated voyage. "We're not talking about an iceberg that's down the line," he says. "The ship has hit the iceberg. We're taking on water. We already have people dying. Not only of CRE, but of untreatable CRE."
So far, these infections are still relatively rare. And they have been seen only in hospitals.
The big fear is that they'll start to move out of hospitals and into the communities around them. "If CRE spreads out of hospitals and into communities, that's when the ship is totally underwater and we all drown," Spellberg says.
To prevent that from happening, the CDC and others are calling on hospitals to contain CRE. "We can nip this in the bud. But it's going to take a lot of effort on the part of hospitals," Frieden says
The first thing hospitals need to do is test patients to see if they have these bugs. "The basic steps are finding patients with CRE and making sure they are isolated so that they don't spread it to others," Frieden says.
That includes common-sense things like keeping them away from other patients and sterilizing everything they come into contact with.
"We know that this can stop outbreaks. It has helped in Florida. It's helped in other countries," Frieden says. "And the good news about this is that it still hasn't spread so widely that we can't stop it."
And doctors have to use antibiotics more carefully to prevent more germs from developing into dangerous superbugs.