California experiences CRE, a super bug outbreak
Approximately 160 people have been exposed to a super bug at California’s Ronald Reagan UCLA Medical Center from procedures with contaminated medical instruments. The hospital…
Endoscopes are responsible for more infections than any other medical devices. (Ano Lobb/ Flickr)
Approximately 160 people have been exposed to a super bug at California’s Ronald Reagan UCLA Medical Center from procedures with contaminated medical instruments.
The hospital issued a warning after seven patients developed antibiotic-resistant infections from Carbapenem-Resistant Enterobacteriaceae, or CRE, during endoscopic procedures between October and January. The infection is thought to have contributed to the death of two of those individuals.
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“We notified all patients who had this type of procedure, and we were using seven different scopes. Only two of them were found to be infected. In an abundance of caution, we notified everybody,” university spokesperson Dale Tate said in a hospital statement, reported by AP. “We removed the infected instruments, and we have heightened the sterilization process.”
A new bacteria outbreak has infected California. (Photo: Shutterstock)
The contaminated instruments are not thought to be the result of hospital negligence. According to Tate, the bacteria remained present despite the fact the instruments were being sterilized at the recommended manufacturer’s specifications. Such is the concern with super pathogens; they tend to mutate to the point where standard kill methods aren’t effective.
CRE is not a single pathogen, but a family of pathogens that have become antibiotic-resistant. CRE is known to be fatal in approximately half of cases, and a report from the LA Times indicates hospitals are the prime location to contract such infections.
Enterobacteriaceae live naturally in the human intestinal system but can cause major issues when they move to the bloodstream or other organs in the body. These bacteria easily become resistant to antibiotic therapy because, as intestinal bacteria, they are exposed to innumerable anitbiotics in an individual’s lifetime.
Though there is no current database specifically monitoring CRE infection, experts say it is fairly common when looking at hospital-related infections. It typically presents from use of contaminated intestinal instruments, like the endoscopes used at Ronald Reagan UCLA Medical Center.
Endoscopes, in particular, are difficult to sterilize. Unlike other medical equipment which can be exposed to extreme heat to kill pathogens, endoscopes are too sensitive to be cleaned in this manner.
The Centers for Disease Control (CDC) note “more healthcareassociated outbreaks have been linked to contaminated endoscopes than to any other medical device” and proper sterilization is paramount to preventing the spread of disease. Endoscopes must be sterilized using germicidal liquids, which are not all made equally, and some are not even approved by the FDA.
It doesn’t take much for bacteria to become resistant. (Nate Congsiriwatana/ Flickr)
“Because of the types of body cavities they enter, flexible endoscopes acquire high levels of microbial contamination (bioburden) during each use,” the CDC explains.
“Disinfectants that are not FDA-cleared and should not be used for reprocessing endoscopes include iodophors, chlorine solutions, alcohols, quaternary ammonium compounds, and phenolics. These solutions might still be in use outside the United States, but their use should be strongly discouraged because of lack of proven efficacy against all microorganisms or materials incompatibility.”
When cleaned properly, endoscopes tested in laboratories have been cleared completely, even from viruses as deadly as HIV. Super bugs may present a new hurdle in the medical world, however.
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Not only are these pathogens immune to common medications, they may even be resistant to modern sterilization processes. The UCLA outbreak serves as an important warning to other medical facilities to review their sterilization routines.
“This bacteria is emerging in the U.S. and it’s associated with a high mortality rate,” Dr. Alex Kallen, an epidemiologist in CDC’s Division of Healthcare Quality Promotion, told the LA Times. “We don’t want this circulating anywhere in the community.”
