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Study: CRE for the first time are spreading outside of health care facilities

Portrait of Sarah Janelle
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For the first time CRE (carbapenem-resistant Enterobacteriaceae) have been detected outside of health care facilities. We asked study author (Dec. 16th in CDC/MMW Report) Sarah Janelle from the Colorado Department of Public Health and Environment about backgrounds and possible effects of this phenomenon.

Mrs. Janelle, how this phenomenon – that for the first time people outside of health care facilities get in touch with this pathogens –  can be explained?

The bacteria that can have carbapenem-resistance (CRE) are normally found in a person’s gut (intestine), such as E. coli, Klebsiella pneumoniae, and Enterobacter species. These bacteria normally do not cause any harm, but if they enter another part of the body such as the bloodstream, an infection can result. Bacteria can either have natural resistance to antibiotics, or can develop resistance through the mutation of genes or by acquiring resistance genes from other bacteria. Anytime antibiotics are used, this puts biological pressure on bacteria that promotes the development of resistance. Inappropriate use of antibiotics (e.g., using antibiotics when they are not needed or not completing an entire course of antibiotics prescribed by a health care provider) accelerates antibiotic resistance in bacteria. Similar to other multi-drug resistant organisms, CRE usually are found in the health care settings but can spread in the community. Since the bacteria that can have carbapenem-resistance are a part of normal gut flora, it is possible that CRE also can occur and spread in the community setting.

Could this also occur with other pathogens that are already resistant against an important antibiotic (eg. MRSA)?

Yes, in fact, MRSA is a good example of an antibiotic-resistant organism that is seen in the community. In the United States, studies show that invasive (life-threatening) MRSA infections are declining in health care settings. However, MRSA infections can occur in the general community and most often cause skin infections. People can carry MRSA in their nose and on their skin without it causing any illness.

Is this phenomenon also observed in other countries, resp. can it be assumed that this is so?

Our study did not look to see if this finding was reported in other countries.

The fact, that CRE may have spread outside of health care facilities, is an alarming situation. What are the next steps for you as a researcher, dealing with this problem?

CRE is a concern to public health – both for patients in the community and in a health care facility – because most antibiotics don’t work; infections caused by these organisms can be serious and even deadly. The Colorado Department of Public Health and Environment, as well as the United States Centers for Disease Control and Prevention, conduct surveillance for CRE to determine if this pattern continues over time. The increase of CRE in patients without health care exposure points to the importance of appropriate antibiotic use. Studies indicate that antibiotics are not always prescribed or used appropriately in hospitals, nursing homes, and in doctor’s offices. It is important for the health care community to prescribe the right antibiotic, at the right dose, at the right time, and for the right duration. Proper use of antibiotics can slow the development of resistance in bacteria, and can preserve this life-saving resource. The general public can wash their hands frequently to prevent all types of infections, including CRE, and should take antibiotics only as prescribed by a health care provider. Health care facilities can prevent the spread of CRE through good hand washing, thorough cleaning and disinfection of surfaces with hospital-grade disinfectants, detecting patients who carry CRE as soon as possible, proper use of gloves and gowns, clearly communicating with other health care facilities when a patient with CRE is transferred from one facility to another, and very important, using antibiotics appropriately.

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