Researchers at Austin Public Health (APH) have found that a particular antibiotic-resistant organism is emerging as a local public health threat that requires immediate action to minimize its spread. APH investigated 37 cases of Carbapenem-Resistant Enterobacteriaceae, or CRE, at Austin area medical facilities in 2017, with 18 of those being Travis County residents. Since 2015, the number of cases and the incidence rate of CRE in Travis County have been increasing. In the November/December issue of the Travis County Medical Society Journal, Austin Public Health summarizes local data on the growing issue of this antibiotic-resistant organism in Travis County.
CRE are associated with high mortality rates (up to 40-50% in some studies) and have the potential to spread widely. They are considered to be one of the top three urgent drug-resistant organisms in the world today. The Centers for Disease Control and Prevention (CDC) estimates that more than two million people are infected with antibiotic-resistant organisms resulting in approximately 23,000 deaths each year.
Background information on CRE and antibiotic resistance:
CRE can be transmitted from person to person on unwashed hands and medical devices.
Patients at highest risk include those in hospitals and nursing homes and those with long-term antibiotic use, compromised immune systems, or invasive devices.
Antibiotic use is the single most important factor in antibiotic resistance, and the CDC estimates that 30-50% of all antibiotics prescribed are either unnecessary or inappropriate.
Fluoroquinolones like Cipro are not the best choice for treatment of uncomplicated urinary tract infections (UTIs) in Travis County.
Most UTIs are caused by E. coli, and Nitrofurantoin and Cephalexin are more effective at killing E.coli than Cipro.
Cipro promotes drug-resistant organisms like the CRE.
Additionally, the FDA issued several warnings against fluoroquinolones in 2018.
In May 2018, the Travis County CRE Taskforce was formed to prevent the spread of CRE in Travis County. Task force members include key stakeholders such as the Texas Antibiotic Stewardship Expert, an Infectious Disease physician, Infection Prevention nurses, Doctors of Pharmacy, microbiology lab managers, the Texas Healthcare-Associated Infection Epidemiologist, and others.
Physicians and other medical providers and staff should follow the CDC’s CRE control recommendations including: judicious use of antibiotics, contact precautions, hand hygiene, timely lab notification, up-to-date inter-facility communication, education to healthcare workers, and guidelines for medical device removal. The CDC’s CRE Toolkit is available here: https://www.cdc.gov/hai/organisms/cre/cre-toolkit/index.html.