German Researchers Find a Surprising Source of Drug-resistant E. Coli in Hospitals

In the fight against healthcare associated infections (HAIs), a main line of defense is stopping drug-resistant pathogens from entering hospitals and treatment centers. A group of German researchers recently published an investigative study on where these deadly bacteria come from and their findings indicate that a surprising number come from the patients themselves.

The study, published in the Journal of Antimicrobial Chemotherapy, included authors from the University of Cologne and the German Center Infection Research. Using stool samples or rectal swabs, the researchers tested more than 4,300 adults upon admission to six German hospitals to see if they were carriers of any multidrug-resistant Enterobacteriaceae (3GCREB). Of those tested, the researchers found that about 9.5% were carriers of 3GCREB, a higher prevalence than previously reported in other studies.

According to Germany’s National Reference Center for Surveillance of Nosocomial Infections, nearly 15,000 people in the country die each year from HAIs. A World Health Organization fact sheet notes that more than 4 million people in Europe experience HAIs every year, with about 30% of patients in intensive care units experiencing at least one.

The researchers in this study focused on the Enterobacteriaceae Escherichia coli. They note that like many bacteria, E. Coli are not pathogenic when they reside naturally in the gut and are make up the naturally-occurring microflora of the intestines. When the bacteria spreads outside of the gut it can be passed between people through contact with feces or wounds, and may then cause serious conditions such as pneumonia and infections in the urinary tract, bloodstream or in wounds. These infections are not only more likely in patients in healthcare settings who have received antibiotics, but they are also highly-resistant to a class of antibiotics used to treat serious infections, in a cycle that vexes the healthcare community worldwide.

This study’s findings showed a higher prevalence of drug-resistant E. Coli in patients being admitted into a hospital than was reported in other studies. In their discussion the authors note that population demographics, previous antibiotic therapy, and regional diet differences such as higher pork consumption may account for the relatively high 9.5% rate of 3GCREB carriers in this study.

“At least for 3GCREB E. coli, patient to patient transmission is not the main mode of transmission,” says study author Axel Hamprecht, MD. “Patients acquire these bacteria rather in their normal life, for example by food, and not from other patients. So isolating these patients for 3GCREB E. coli will not have an impact on the colonization rate but will rather have a negative effect on patient care.” The authors conclude from their research that curtailing drug-resistant infections will require a judicious use of antibiotics while encouraging a combination of prevention and novel treatment approaches.

The Centers for Disease Control and Prevention in the United States says that healthcare workers can help prevent the spread of Enterobacteriaceae by following these steps:

• Washing hands with soap and water or an alcohol-based hand sanitizer before and after caring for a patient
• Carefully cleaning and disinfecting rooms and medical equipment
• Wearing gloves and a gown before entering the room of a CRE patient
• Keeping patients with CRE infections in a single room or sharing a room with someone else who has a CRE infection
• Whenever possible, dedicating equipment and staff to CRE patients
• Removing gloves and gown and washing hands before leaving the room of a CRE patient
• Only prescribing antibiotics when necessary
• Removing temporary medical devices as soon as possible
• Sometimes, hospitals will test patients for these bacteria to identify them early to help prevent them from being passed on to other patients