Using the web to track spread of drug-resistant bacteria

CRE bacteria

Until Tom Frieden, MD and director of the Centers for Disease Control and Prevention, held a news conference earlier this month to talk about the increase of carbapenem-resistant Enterobacteriaceae, or CRE, it was pretty likely that not many people had heard the term before.

CRE are deadly bacteria, even stronger than MRSA (methicillin-resistant Staphylococcus aureus), and are resistant to nearly all of the antibiotics that exist today. CRE can cause a variety of infections ranging from gastrointestinal illness to pneumonia to invasive infections of the bloodstream or other body organs.

CRE germs are not very common, but the prevalence is increasing. About four percent of 4,000 hospitals in the U.S. reported at least one patient with a CRE infection in 2012, an increase from one percent a decade ago.

Frieden called CRE a “nightmare” bacteria. “Our strongest antibiotics don’t work and patients are left with potentially untreatable infections,” he said.

In the news conference, Frieden urged healthcare leaders to help stop the infections from spreading.  Over the last decade, medical facilities in 42 states have reported CRE cases.

Researchers and computer programmers from Seattle Children’s Research Institute and the University of Iowa are tracking CRE cases via an online surveillance system called CaseFinder.

CRE more common in Northeast

In Washington state, the Department of Health started tracking cases of CRE in October 2012. A total of 15 cases have since been reported, said Scott Weissman, MD, of Seattle Children’s Research Institute. Weissman’s lab tests and studies the CRE collected from around the state.

“Overall, numbers of CRE in Washington state are very low,” said Weissman. “Cases of CRE are more prevalent in the Northeast and Midwest. Thus far, CRE seems to affect elderly patients with underlying medical conditions more than young, otherwise healthy patients.”

Online surveillance tool aims to track CRE

One of the unique properties of CaseFinder is that it’s intended to be real-time, showing when and where outbreaks occur and then spread. “Ideally, we’ll know about new cases of CRE as soon as a clinician enters a case,” said Weissman. There’s also the potential for follow-up molecular testing in Weissman’s lab when a case pops up on the map.

“The seed for the idea of a CRE registry was planted last January, when a colleague posed a question on a national listserv about treatment recommendations for a complicated polymicrobial wound infection in a traveler returning to the U.S. from India,” Weissman said. “This ended up being the first case of the New Delhi Metallo-beta-lactamase (NDM) detected in Washington state.”

If that sounds like a scene from 2011 movie, “Contagion,” it’s not far off the mark of what’s taking place. “Disease surveillance is crossing into a new realm, learning to move as quickly as the germs we are tracking,” he said.

Weissman said the rising incidence of CRE is symptomatic of a larger problem—the overuse of antibiotics across the globe. To help prevent the spread of these infections, the CDC offers up the tips below.

CDC’s Tips for Patients to Help Prevent CRE Infections:

•    Tell your doctor if you have been hospitalized in another facility or country.
•    Take antibiotics only as prescribed.
•    Insist that everyone wash their hands before touching you.
•    Clean your own hands often, especially:
•    Before preparing or eating food
•    Before touching your eyes, nose or mouth
•    After changing wound dressings or bandages or handling medical devices
•    After using the bathroom
•    After blowing your nose, coughing or sneezing