Once again, current events have brought a newer superbug into the spotlight and heightened public interest in a dangerous and drug-resistant pathogen. CRE, or carbapenem-resistant Enterobacteriaceae is in the news and people are concerned.
This pathogen is actually a family of bacteria, not a single species, as Enterobacteriaceae is a broad grouping of Gram-negative bacteria including E. coli, Klebsiella pneumoniae, and Salmonella species, as well as many harmless bacteria. What sets this group apart? This group recently acquired the ability to resist the carbapenem class of antibiotics.
Carbapenem antibiotics are broad-spectrum, meaning they are effective against many different types of bacteria, and are usually not affected by bacterial defense mechanisms to other antibiotics. As we’ve explored in the blog before, over time, bacteria can develop new mechanisms to defeat once-effective medicines, and such is the case with the CRE group. These bacteria have now evolved to produce an enzyme that can defeat carbapenem drugs.
The nature of the collective grouping of the bacteria limits our ability to describe one type of CRE infection, as they vary in where the infection occurs and how it presents (symptoms). What they do have in common, however, is a high mortality rate. Some reports claim 48% of patients with CRE will not survive. These infections tend to occur less in otherwise healthy patients, while the elderly and immunosuppressed are more vulnerable.
Few drugs remain that can be utilized to treat a patient with a CRE infection. A complicating factor with any resistant infection is that while the patient’s infection is being diagnosed, we utilize broad-spectrum antibiotics in an effort to stem the infection, then move to a targeted type of antibiotic after diagnosis. Hopefully, new technology will help us to find the right drug sooner, since most patterns of resistance are to the broad-spectrum antibiotics.
We also see more CRE cases in patients whose treatment requires a ventilator, catheter, central IV line, or other medical devices that create an entrance path to the body. The case of UCLA patients being exposed to CRE via endoscopes is a good example of a medical device-related HAI. While some HAIs are acquired from the environment, others are conveyed from devices like indwelling catheters. Research shows that almost every type of HAI can be impacted by keeping our hands and the environment as clean as possible, even those that are related to medical devices.
Xenex’s Full Spectrum™ UV-C is not slowed by any type of antibiotic resistance, and we’ve shown this in lab and real-world studies against VRE and MRSA (both resistant organisms). We’ve been proven effective against E. coli, Klebsiella, and many other pathogens of the Enterobacteriaceae family. While our application does not disinfect endoscopes or other invasive medical devices, keeping the hospital environment free of pathogens is a key step towards reducing the transfer of those pathogens to patients.
Rachael Sparks is the Technical Director at Xenex Disinfection Services and was previously a transplant specialist working with hospitals throughout Texas.