The March of Antibiotic Resistance Leads to Another CRE Outbreak

Today there was much attention devoted to the "superbug" outbreak involving a California hospital. The basic facts surrounding this event are that duodenoscopes, a telescopic medical device used during ERCP procedures, were found to be contaminated with carbapenem-resistant Enterobacteriaceae (CRE). An ERCP is a procedure employed to evaluate the pancreas and bile ducts and is an essential part of modern medical diagnosis treatment for myriad conditions. Thus far, 7 people were infected with 2 succumbing to their infections; 179 were exposed from October 2014 through January 2015.

A couple of important points regarding these events:

  • Expect more CRE outbreaks as the march of antibiotic resistance continues
  • This type of hospital-acquired (nosocomial) infection is exactly what is meant by antibiotic resistance threatening modern medicine (i.e. can procedures be performed safely when the risk of contracting an untreatable infection is considerable)
  • Anytime one has a breach of an immune defense, there is risk for infection. Sticking an intricate and flexible telescope through the mouth into the small intestine is most definitely a breach (albeit one that is necessary to treat and diagnose certain conditions)
  • Scope related infections are nothing new and this outbreak reinforces the need for device sterilization to be performed meticulously and without fail (at my institution gas sterilization using ethylene oxide has been employed with great success since an 18 person outbreak was uncovered)

CRE are labeled an urgent threat by the CDC because they are near impossible to treat and have a high attributable mortality.  As this outbreak remains in the headlines I believe it is an important opportunity to reiterate to the public that this is the end result of injudicious antibiotic use and there is a desperate need for new approaches to combat bacterial infections (monoclonal antibodies, vaccines, bacteriophages, lysins, antimicrobial peptides, virulence disruptors).

The often unwarranted demand for antibiotics--and physician acquiescence--must stop or else the antibiotic age, which dawned in the first half of the 20th Century, will become a mere memory.