The Free Press, Mankato, MN

March 9, 2013

Health care providers keep watch for resistant germs

By Robb Murray
Free Press Staff Writer

— When the Centers for Disease Control and Prevention issued a statement about the so-called “nightmare bacteria,” they did with statements such as this:

“It’s not often that our scientists come to me and say we have a very serious problem and we need to sound an alarm,” the CDC director told reporters at a news conference last week. “But that’s exactly what we’re doing today.”

Since then, talk of this new infection (called carbapenem-resistant enterobacteriaceae or CRE) that is resistant to nearly every form of antibiotic has been the talk of the nation.

Not since the MRSA (methicillin-resistant staphylococcus aureus) infection scare hit several years ago has so much talk circulated about an infection that could kill us all.

But just how dangerous is this new infection and how worried should you be?

Despite what the head of the CDC says, local sources say it’s not quite time to panic.

“We want to make sure hospitals are ready for it,” said Brad Krier, a Minnesota Department of Health epidemiologist who works out of Mankato.

They have a Department of Health “tool kit” that offers a set of protocols to hospitals when it comes to dealing with infections. If medical professionals follow those protocols, he said, there should be little to worry about.

“If they’re successful, it shouldn’t get out into the community,” Krier said. “It’s similar to MRSA. That used to be a hospital-acquired infection, but it got out into the community.”

For the record, there haven’t been many CRE cases in Minnesota. But there is no doubt the number of CRE cases is growing. In Minnesota in 2011 there were 44 cases. In 2012, that number jumped to 90.

The majority of those were in the Twin Cities area, where Hennepin and Ramsey counties are under active surveillance by the state’s Department of Health for infectious diseases. The rest of the state’s counties report their cases to the state when they occur, and Kriel said he didn’t know whether there have been any CRE cases in southern Minnesota.

At Mayo Clinic Health System in Mankato, they do an active surveillance on certain populations within the hospital and pay particular attention to patients who might have more devices or lines. They also analyze all lab cultures daily to find those that are drug resistant.

Sue Trubenbach, infection preventionst and registered nurse at the hospital, said the most common such infection is MRSA, something that has become relatively common in recent years.

CRE has been on their radar for several years.

“We’ve been hearing about this since 2009,” she said. “Patients, residents, everyone just needs to be more in tuned to hand cleaning. And it’s good to raise awareness.”

Hospitals aren’t the only ones dealing with infection.

Nursing homes also have protocols in place for dealing with infection. But in their case, they have an added twist. Even if they think a case may call for isolation, they need to consider a patient’s mental well-being, too.

Amy Jungmann, program director of occupational health and staff development for Thro Company, which operates several nursing homes and assisted-living facilities in the region, said they try to make sure their residents don’t feel isolated from social functions within the facility.

She said they haven’t seen any CRE in the Thro facilities, but the robust influenza season has allowed them to put their infection-fighting protocols to the test, so if anything more serious does arrive, they’ll be ready.

“We certainly have had a rough winter for influenza,” Jungmann said. “We do daily active and passive surveillance. We look for trends or any kind of increase, we do isolation.”

In addition to influenza, Jungmann said they’ve seen an increase in something called clostridium difficil.

“This one can be particularly unpleasant and can cause toxic megacolon (an acute form of colonic distention).”

Krier said he wants people to take CRE seriously — after all, 50 percent of the most serious cases end in death. But he’s hoping hospitals can redouble their efforts at proper antibiotic prescription and everyone can employ smart hand-washing policies.