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CDC microbiologist Alicia Shams demonstrates Klebsiella pneumoniae bacteria growing on a plate. / Jim Gathany, CDC

Superbugs known as CRE - called "nightmare bacteria" by federal health officials because they are deadly and virtually untreatable - are skyrocketing in the Southeastern USA, new research shows. Experts fear a growing national problem, and some say the spread of such superbugs may portend a "post-antibiotic era."

Cases of the antibiotic-resistant CRE rose fivefold in community hospitals in the region from 2008 to 2012, researchers at Duke University Medical Center found, and they said those rates are likely underestimates.

"We're trying to sound the alarm. This is a problem for all of us in health care," said Deverick J. Anderson, senior author of the study and an associate professor of medicine at Duke. "These (bacteria) are just about as bad as it gets."

CRE, short for carbapenem-resistant Enterobacteriaceae, are a family of bacteria that have over time become resistant to last-resort antibiotics. They prey mostly on vulnerable, hospitalized patients and kill nearly half who get bloodstream infections.

CRE are the worst of the worst in a growing sea of pernicious germs resistant to antibiotics that take hold in sick patients in health care settings. According to the U.S. Centers for Disease Control and Prevention, one in 25 hospitalized patients has at least one health care-associated infection on any given day.

Two of the more common superbugs are C. difficile, which is rising steeply and is linked to about 14,000 American deaths each year, and MRSA, which has been a problem in hospitals for decades. Researchers point to a recent decrease in invasive MRSA infections but estimate there were still more than 80,000 in 2011. MRSA has spread beyond hospitals into communities.

The emergence and spread of these superbugs could be fueled by the overuse of antibiotics and gaps in infection control in hospitals and long-term care facilities. Lapses occur even though hospitals and government health agencies educate doctors and other health care workers about hand-washing and room-cleaning. Activists said doctors turn too often to antibiotics - sometimes at a patient's or parent's insistence - for sore throats, coughs or other common ailments.

"That needs to stop," said Kevin Kavanagh, an infection-control activist who leads the watchdog group Health Watch USA in Somerset, Ky. "It's creating a huge problem."

The federal government doesn't track individual cases, but the CDC issued warnings last year about CRE, saying the bacteria spread from one medical facility in 2001 to numerous facilities in 46 states in 2013. CDC Director Tom Frieden, who dubbed them "nightmare bacteria," said, "Our strongest antibiotics don't work, and patients are left with potentially untreatable infections."

Anderson's study, in the current issue of the journal Infection Control and Hospital Epidemiology, found the CRE detection rate rose more than fivefold within the Duke Infection Control Outreach Network, a cluster of 25 community hospitals in North Carolina, South Carolina, Virginia and Georgia.

Anderson said rates have probably risen just as much nationally at small community hospitals, "which are the main type of hospitals in the U.S."

CRE-related illnesses vary by where the germ infects the body and range from gastrointestinal illness to pneumonia to bloodstream infections. Though all superbug infections are difficult to treat, CRE is among the least treatable and deadliest.

"We're really just running out of (treatment) options," Anderson said.

"So far, CRE are just in the health care setting," Kavanagh said. "If it continues to grow and escape into the community, it will be an even bigger problem," and the medicines doctors count on to cure bacterial infections will no longer work against them.

He said antibiotics should be used only when they are absolutely necessary, and hospitals must remain vigilant about ensuring health care workers wash their hands often, keep rooms and medical equipment clean, wear gowns and gloves when appropriate and separate infected patients from others.

If the spread of CRE isn't prevented, "we'll be in a post-antibiotic era," Kavanagh said. "And the danger is not going to go away unless we change the course of how we do things."

Laura Ungar reports for The (Louisville, Ky.) Courier-Journal



Copyright 2014USAToday

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