VANCOUVER, B.C. - There’s a new bad bug on the block, and it appears to be making appearances in long-term care facilities, at least in the Chicago area, according to a recent study presented at the annual meeting of the Infectious Diseases Society of America.
Carbapenem-resistant Enterobacteriaceae, particularly those that produce Klebsiella pneumoniae carbapenemase (KPC), are becoming increasingly problematic in the Chicago area, Dr. Mary K. Hayden said during a press briefing. The first case appeared in Chicago in December 2007, but by March 2009 an Internet-based survey of infection preventionists revealed that 26 of 53 facilities (49%) had reported one case, and the mean number of cases per facility was 3.8.
In a subsequent survey in February 2010, 37 of 57 facilities (65%) had reported at least one case, and the mean number of cases per facility was 10.2.
According to the 2009 survey, 81% of the affected patients had been transferred from a long-term care facility or a long-term acute care hospital. In 2010, 75% of patients came from such facilities.
Dr. Hayden, of Rush University Medical Center, Chicago, declined to refer to KPC as a "superbug," a term favored in the popular press, but she did say, "I think it is an organism that should be identified as requiring particular attention. [It] can cause serious, life-threatening infections in hospitalized patients."
These organisms, aerobic gram-negative bacilli, produce infections that are particularly difficult to treat because they’re resistant to most and sometimes to all available antibiotics.
"This rapid increase in KPC is not unique to the Chicago area," Dr. Hayden said. "KPC was first identified in North Carolina in the late 1990s, and over the next 10 years remained restricted to the East Coast, causing significant morbidity and mortality in areas such as Brooklyn, N.Y. But in the last couple of years, KPC has spread globally, with reports now from multiple areas in the United States and from South America, Europe, and Asia. An extreme example was seen in Israel, which reported a nationwide outbreak of KPC only about 2 years after their first case was identified."
Dr. Hayden said that her team believes their findings point to the need for a regional approach to KPC control. "It will require coordinated collaboration between acute care hospitals, long-term care facilities, and public health [departments]," she said.