By Thomas Cumbo
Niagara Gazette — Recently, local media have been discussing relatively new forms of antibiotic-resistant bacteria that are making their way around the world called carbapenemase-producing Enterobacteraciae (CRE). In layman’s terms, this group represents a number of related microorganisms that have genes inside them that code for resistance to most, if not all, known antibiotic medicines. When exposed to different antibiotics, some bacteria develop resistance to the drug and can pass these resistance genes onto future generations of bacteria. Previously more prevalent overseas where the use of antimicrobial medicines can sometimes be more brazen and are often available without a prescription, they are now making their way to the US and Canada. At this point they usually, but not always, tend to cause disease in patients who are in poorer health or are otherwise compromised, such as those who have cancer or have undergone surgery. Nonetheless, they are quite worrisome and create an impetus to ensure we do all that we can to practice proper infection control, both in the community and the hospital setting.
The mechanisms behind the evolution and expression of these genes, while fascinating, are beyond the scope of this article. Suffice it to say that they are posing an enormous challenge. Treatment of patients infected with these organisms is very difficult and requires the use of salvage and/or toxic medications that often carry dangerous side effects. Despite the use of these drugs, mortality still remains very high. Unfortunately, the types of bacteria that carry these resistance genes are frequent causes of common infections such as those involving the urinary tract and surgical sites. Take, for example, the very common occurrence of a young lady contracting a urinary tract infection. Now imagine that it is caused by one of these bacteria and not being able to easily treat it, if at all, and you can start to appreciate the serious nature of this problem.
What can the medical community do? Despite the known presence of these pathogens in New York, here at Mount St. Mary’s Hospital, we have thankfully had very little exposure to these organisms so far. We actively screen all positive cultures for evidence of this type of organism and have a plan in place if one is identified. We also have a robust infection control and antibiotic stewardship program. We strive to use the narrowest-spectrum antibiotic possible for the shortest time necessary while still properly treating the patient. This is a difficult juggling act, but it allows us to protect as much of the “good” bacteria in the patient’s body as possible. These good bacteria live harmlessly within our bodies and are one of our best defenses against the development of disease. Their presence helps crowd out bad bacteria by denying them a place to establish themselves. In addition, we actively monitor and remove all catheters and IV lines when no longer necessary. These devices can and do provide a “safe zone” for these pathogens and facilitate their entrance into normally sterile portions of a patient. Finally, we try to minimize your time in the hospital as much as is possible to help avoid exposure to hospital acquired infections.
What can you do? The usual advice still applies. Wash your hands regularly and avoid antibiotics unless prescribed by your doctor. Do not try and pressure your physician into prescribing antibiotics over the phone or for what he or she feels is a viral illness. If you’re in the hospital yourself or visiting loved ones, please follow all infection control mandates including the use of gowns and gloves if instructed to do so by your nurse. Together we can help keep these dangerous bugs out of our community and keep our families safe.
Thomas Cumbo, M.D., is the head of the Division of Infectious Disease at Mount St. Mary’s Hospital.Thomas Cumbo, M.D., is the head of the Division of Infectious Disease at Mount St. Mary's Hospital.