Dennis J. Stevens, PhD
Killers Among Us


Killers Among Us: CRE Superbugs 


We are engaged in a struggle to survive against toxic superbugs that swarm hospitals and both, long-term and acute care facilities. After more than 7 decades of antibiotic use, report medical doctors, critical patterns of antimicrobial resistance have been associated with high rates of morbidity and mortality among institutionalized patients regardless of the health issues that brought them to the facility. How many stories can you recall (or tell me) about people going in for something small only to be eaten alive by “mrsa” or other unknown bugs? Mrsa is not a virus and is linked to the super bug family. Superbugs or Carbapenem-Resistant Enterobacteriaceae (CRE) are resistant to all known antimicrobial agents. US Centers for Disease Control and Prevention (CDC) identified the first case of CRKP at a North Carolina long-term care facility. Today, the CRE carbapenem-resistant Klebsiella pneumoniae (CRKP) is the most highly resistant pathogen documented as residing at health care facilities in 40 states, reports Bridget Kuehn (2012).  Another report clarifies that the CRE killer is global. None of these findings have encouraged sufficient progress toward stringent control measures by government and medical authorities. Also, there has been little if any appropriate research into therapeutic and preventive strategies. A common response during my interviews with several institutional medical experts is that CRE superbugs represent a present and immediate danger to all life forms on this planet. Interviews with surviors are compelling and heartbreaking.  

                     "The ongoing explosion of antibiotic-resistant infections continues to plague global and US health care.   

                       Meanwhile, an equally alarming decline has occurred in the research and development of new antibiotics

                       to deal with the threat.

In response to this microbial “perfect storm,” my next book, Killers Among Us: CRE Superbugs will (see explore the updated recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) for the control of CRE or carbapenemase-producing Enterobacteriaceae. Equally important, surveys will be sent and interviews will be conducted among the approximate 5,000 registered hospitals with an emphasis on prison hospitals administrators to determine their therapeutic and preventive strategies to identify, isolate and ultimately resolve those CRE killers. One expectation of this writer is that our humans as species will die before appropriate strategies can be operationalized. You can be assured that of the 37 million new patients admitted to American hospitals each year and the tens of thousands prisoners visiting medical facilities that prisoners will die first. Not sure if that means before those prisoners are released or if it means that of the 650,000 prisoners released each year that most of them will die after moving in next door to you.




Infections With 'Nightmare Bacteria' Are On The Rise In U.S. Hospitals


Federal officials warned Tuesday that an especially dangerous group of superbugs has become a significant health problem in hospitals throughout the United States.

These germs, known as carbapenem-resistant Enterobacteriaceae, or CRE, have become much more common in the last decade, according to the Centers for Disease Control and Prevention. And the risk they pose to health is becoming evident.

"What's called CRE are nightmare bacteria," Dr. Thomas Frieden, director of the CDC, tells Shots. "They're basically a triple threat."

First of all, they are resistant to virtually all antibiotics, including the ones doctors use as a last-ditch option.

Second, these bugs can transfer their invincibility to other bacteria. "The mechanism of resistance to antibiotics not only works for one bacteria, but can be spread to others," Frieden says.

Third, the bacteria can be deadly. Infection with the bacteria "have a fatality rate as high as 50 percent," Frieden says.

Although the resistant bacteria potentially pose a risk to anyone, people whose immune systems are weaker, such as elderly people, children and people who have other health problems, tend to be most susceptible to infection.

If the drug-resistance starts to spread from bacteria that are usually a problem in hospitals to much more widespread causes of infections, the risk could rise even more. "If it spread to things like E. coli, which is a common urinary tract infection, it would be a very serious problem," Frieden says.

The CDC sounded the alarm because of data that show the proportion of bacteria that have this resistance to many drugs has quadrupled in the last decade or so.

CRE cases were reported by 4 percent of hospitals in 2012, up from about 1 percent from about a decade earlier, according to the report. In long-term care hospitals the situation is even worse — about 18 percent have reported cases, the CDC says.

In addition, the proportion of Enterobacteriaceae bacteria that were resistant increased from 1.2 percent in 2001 to 4.2 percent in 2011, the CDC reported.

"And that's for the whole family." says Dr. Arjun Srinivasan, the CDC's associate director for health care-associated infection-prevention programs. "When we look at one member of this family, a bacteria called Klebsiella, which is the most common type of CRE that we see in the United States, resistance there has gone from about 2 percent to over 10 percent. So a dramatic increase in the frequency with which these organisms are being seen in our hospitals in the United States."

Infectious disease specialist Dr. Brad Spellberg, of the Los Angeles Biomedical Research Institute at the Harbor-UCLA Medical Center, likens the situation to the Titanic's ill-fated voyage. "We're not talking about an iceberg that's down the line," he says. "The ship has hit the iceberg. We're taking on water. We already have people dying. Not only of CRE, but of untreatable CRE."

So far, these infections are still relatively rare. And they have been seen only in hospitals.

The big fear is that they'll start to move out of hospitals and into the communities around them. "If CRE spreads out of hospitals and into communities, that's when the ship is totally underwater and we all drown," Spellberg says.

To prevent that from happening, the CDC and others are calling on hospitals to contain CRE. "We can nip this in the bud. But it's going to take a lot of effort on the part of hospitals," Frieden says

The first thing hospitals need to do is test patients to see if they have these bugs. "The basic steps are finding patients with CRE and making sure they are isolated so that they don't spread it to others," Frieden says.

That includes common-sense things like keeping them away from other patients and sterilizing everything they come into contact with.

"We know that this can stop outbreaks. It has helped in Florida. It's helped in other countries," Frieden says. "And the good news about this is that it still hasn't spread so widely that we can't stop it."

And doctors have to use antibiotics more carefully to prevent more germs from developing into dangerous superbugs.