Ask The Pharmacist – CRE Superbug Infections
Seven patients at a UCLA’s Ronald Reagan Medical Center have been infected with a drug-resistant “superbug” called CRE and two people have died. The cause, the reuse of a medical device that was not sterilized even though it went through recommended cleaning procedures
Doctors use duodenoscopes or endoscopes to look at the stomach and small intestine, to drain harmful fluids from the gall bladder or pancreas, or to remove blockages in that area right below the stomach. The tubes go down the throat into the stomach and then to the small intestine. The tip of this flexible scope has many nooks and crannies where the light and camera are, where a tube drains fluids, or where another tube allows doctors to administer fluids. After the procedure is over, the scope is removed and sent for cleaning and sterilization. Manufacturers have a cleaning procedure that they recommend but in this case, it was insufficient and a person who had CRE, or Carbapenem Resistant Enterobacteriaceae, contaminated the scope and when it was reused, the next person was exposed and so on and so forth. All in all 179 people were exposed to that scope over a several month period, seven became ill as a result, and two people have died. It could definitely happen here because the standard cleaning and sterilization procedures are not sufficient. While I am sure that hospitals throughout the country are even more vigilant and some are using an extra gas sterilization step, the additional benefits of this procedure have not been established.
Enterobacteriaceae are part of a family of bacteria like E Coli and Klebsiella which the viewers might be familiar with. E Coli is a gut bacteria that is the most common cause of urinary tract infections so it is a concern. CRE bacteria have developed enzymes that break down antibiotics before it can kill the bacteria. Instead of using the most common antibiotics, doctors have to use much older antibiotics with more side effects like aminoglycosides or combination therapy and even then, it doesn’t always work to cure people and about 50% of people with a serious CRE infection die. Now, most people who are exposed to CRE, just like most people who are exposed to MRSA, do not get an infection at all. Having a strong immune system, having a lot of good bacteria to crowd out the bad and stop it from growing out of control, and not having open wounds or lesions prevent it from reaching the deep tissues or blood is critical. Of the 500,000 procedures done each year, there are about 100 people who develop CRE?
The government recently came out with some guidance for health systems and patients. The recommend that doctors have a higher suspicion about the possibility that scopes can be a cause of infectious spread, to stop using a scope if a patient develops an infection with CRE after use until it can be proven to be safe, and to report suspected cases to the FDA right away. For patients, understand the need for a procedure using a duodenoscope and compare the benefits to the very small risk of infection posed by its use. While most people will routinely get a sore throat and mild abdominal discomfort after using this scope, report severe pain, trouble swallowing or breathing, nausea and vomiting, or black stools to your doctor right away. The sooner you get treatment for CRE, the better off you are.
Michael White; Dept. Of Pharmacy Practice, UConn School Of Pharmacy