Aggressive Containment Combats Spread of Nightmare Bacteria

In a telebrief presented on April 3, 2018, the Centers for Disease Control and Prevention (CDC) discussed how its coordinated efforts with health departments at the local and state levels are protecting individuals by stopping the spread of new and unusual types of antibiotic resistance throughout the United States.

CDC has implemented the nationwide Antibiotic Resistance Laboratory Network (ARLN) to facilitate prompt analysis of bacterial samples forwarded by local and state health departments. And, in a Vital Signs report released on April 3, CDC details how the network identified microbes with new or unusual antibiotic resistance genes in the United States in the first nine months of 2017.

According to CDC’s Principal Deputy Director, Anne Schuchat, MD, RADM, USPHS, ARLN tested 5,776 specimens from patients in US healthcare facilities such as hospitals and nursing homes across 27 states in 2017 and found 221 instances of microbes with new or unusual types of antibiotic resistance.

Because of the high level of antibiotic resistance in these microbes, they have been labeled “nightmare bacteria.” They include carbapenem-resistant Enterobacteriaceae (CRE), which encompass a range of bacteria, such as Klebsiella pneumoniae and Escherichia coli. Because “nightmare bacteria” are capable of spreading genes that make them resistant to most antibiotics, they can be untreatable or very difficult to treat, said Dr. Schuchat.

These bacteria can cause very serious infections, she noted, including pneumonia, urinary tract infections, and bloodstream infections. Furthermore, studies suggest that up to 50% of infections with these bacteria can lead to death, she added.

“The most dangerous antibiotic-resistant threats are the ones that we don't know about,” said Arjun Srinivasan, MD, CDC's Associate Director for Healthcare Associated Infection Prevention Programs, in an interview with Contagion ^®. “Experience shows us that, left undetected, resistant bacteria spread, and by the time we realize what's happened, they have spread widely. This problem is very much like a fire—easy to put out when small, but much harder when larger.”

However, according to Dr. Schuchat, the good news is that data shows that an aggressive containment approach can effectively combat the spread of these types of antibiotic resistance. CDC’s containment strategy involves a coordinated and collaborative response among health care facilities, laboratories, health departments, and CDC through the ARLN.

The strategy essentially calls for rapid detection of resistant bacteria, use of infection control measures (including wearing gowns and gloves when examining patients), screening of asymptomatic patients who may carry and spread the bacteria, and continued use of infection control measures and evaluation of infection control until the spread of resistance stops.

Fortunately, this containment approach helps to stop resistant bacteria before they spread widely, Dr. Srinivasan told Contagion ^®. “The new laboratory testing network, the ARLN, allows us to detect new resistant threats faster than we ever could before. And, support to health departments has created teams of resistance ‘firefighters’ who are trained and ready to help healthcare facilities and providers stop the spread of resistance as soon as it's detected.”

At the patient level, Dr. Srinivasan stressed the need for clinicians to ensure that the affected patient receives the right treatment and that the resistant organism does not spread to other patients. “The good news is that no one has to do this alone,” he said.

“To help treat complicated infections, clinicians can rely on support from their infectious disease-trained colleagues,” said Dr. Srinivasan. To help prevent the spread of the resistant organism, the clinician can work with the hospital infection control and healthcare epidemiology team, as well as with the health department.” Together, these experts can help to ensure that all of the right measures are in place to keep the organism from spreading and, when needed, can arrange for testing of other patients to look for silent spread of resistance.

“Most of these organisms have been found in inpatient facilities, hospitals, and nursing homes, noted Dr. Srinivasan. “Facilities where these organisms are found should make sure their clinicians and infection control staff have the resources they need to respond. They should work closely with the health department to ensure that other facilities that might be at risk for these organisms—for example, one where the patient might have previously stayed—are also contacted,” he concluded.

Dr. Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals and has also served on the American College of Veterinary Pathologists’ Examination Committee and Education Committee.