Superbug Infection

1
Superbug Infection

• Dr Jose Poulose

2
What is a superbug?

• Real name is Carbapenem Resistant
  Enterobacteriaceae.
• Reported from Ronald Reagan UCLA Medical Center,
  Los Angels, CA
• It is sometimes called the nightmare bacteria,
  as it does not respond to antibiotics.
• Probably more common than the number of reported
  cases.

3
Superbug what do we know so far?

• Two deaths at the California medical center are
  linked to the bacteria.
• Five other patients are infected and nearly 200
  may have been exposed, the center says.
• Exposure stemmed from two contaminated
  instruments used during procedures done over the
  past few months at the facility.

4
Incidence and a case study

• CRE causes an estimated 9300 cases per year and
  600 deaths in the United States.
• A case was reported in Reno, Nevada. The patient
  was a 70 year old woman returning from India. She
  was hospitalized in India two months before her
  return due to complications from a femur
  fracture.
• This patient subsequently died as all the 26
  available antibiotics were ineffective to treat
  her. In spite of the best efforts by doctors, she
  developed septic shock and multiorgan failure,
  resulting in her death.
• The saving grace-this patient was in a single
  room and did not cause exposure to other
  patients!

5
Additional Points

• CRE is in a family of bacteria that are normally
  found in the gut and have become resistant to
  antibiotics.
• They are resistant to most of the available
  antibiotics.
• The devices linked with the UCLA outbreak, known
  as duodenoscopes, are used in more than 500,000
  procedures a year in the U.S., according to the
  CDC.

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Two types of CRE

• "There are two primary types of CRE.
• One of them is called New Delhi
  metallo-beta-lactamase, or NDM, and another one
  is called Klebsiella pneumoniae carbapenemase, or
  KPC," as per Lei Chen, senior epidemiologist for
  the Washoe County Health District.
• Both strains both have specific enzymes that can
  break down carbapenem antibiotics, rendering
  these powerful drugs ineffective, explained Chen.
  Generally, KPC is more prevalent in the US than
  NDM The CDC recorded 175 NDM cases as of January
  6.

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Additional Points

• The problems can start when the bacteria leave
  the intestine and live in other areas, such as
  the urinary tract, lungs, skin, and on medical
  equipment.
• The infection is caused when the bodys natural
  immunity breaks down.
• For the same reason, it is uncommon among healthy
  people.
• Seen among people living in Nursing Homes, Long
  Term care facilities and those with prolonged
  hospitalizations.

8
Incidence and severity

• During the last decade, CRE infections have been
  reported in 42 states, according to the CDC.
• About 4 of U.S. hospitals had at least one
  patient with a CRE infection in the first half of
  2012, as per CDC
• 18 of long-term acute care hospitals did.
• As Per CDC, 40-50 of the patients with the
  infection may die.

9
Treatment

• Doctors may try Carbapenem group of antibiotics.
• More than one antibiotic is needed at times.
• At this point of time, it is more of a trial and
  error method as well as standard treatment for
  sepsis.

10
Prevention is better than CURE

• Hygienic precautions by Health Care Workers-
  Something as simple as washing the hands with
  soap and water.
• Attention to sterile precautions of instruments.
• Decreased length of stay at the hospitals.
• Let us hope and pray that it will not become a
  mass epidemic.