Hospitalists on Alert as CRE Infections Spike


Hospitalists should be on the lookout for carbapenem-resistant Enterobacteriaceae (CRE) infections, says one author of a CDC report that noted a three-fold increase in the proportion of Enterobacteriaceae bugs that proved resistant to carbapenem within the past decade.

Earlier this month, the CDC's Morbidity and Mortality Weekly Report revealed that the percentage of CRE infections jumped to 4.2% in 2011 from 1.2% in 2001, according to data from the National Nosocomial Infection Surveillance system.

"It is a very serious public health threat," says co-author Alex Kallen, MD, MPH, a medical epidemiologist and outbreak response coordinator in the CDC's Division of Healthcare Quality Promotion. "Maybe it's not that common now, but with no action, it has the potential to become much more common, like a lot of the other MDROs [multidrug-resistant organisms] that hospitalists see regularly. [Hospitalists] have a lot of control over some of the things that could potentially lead to increased transmission."

Dr. Kallen says HM groups can help reduce the spread of CRE through antibiotic stewardship, the review of detailed patient histories to ferret out risk factors, and dedication to contact precautions and hand hygiene. Hospitalists also play a leadership role in coordinating efforts for patients transferring between hospitals and other institutions, such as skilled-nursing or assisted-living facilities, he says.

Dr. Kallen added that hospitalists should not dismiss CRE, even if they rarely encounter it.

"If you're a place that doesn't see this very often, and you see one, that's a big deal," he adds. "It needs to be acted on aggressively. Being proactive is much more effective than waiting until it's common and then trying to intervene."

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