In a disturbing sign, a formidable superbug has left the hospital and appears to be spreading in the community in the absence of healthcare contact.
A recent population study by the Centers for Disease Control and Prevention (CDC) found that 10% of people with carbapenem-resistant Enterobacterales (CRE) had no healthcare exposure.1
The CDC rates CRE as an “urgent threat,” the highest rating in the pantheon of antibiotic-resistant pathogens in a 2019 report on the rising tide of multidrug resistant bacteria.2
“Patients who require devices (e.g., catheters) and patients taking long courses of some antibiotics are most at risk for CRE infections,” the CDC reported. “CRE can carry mobile genetic elements that are easily shared between bacteria. Approximately 30% of CRE carry a mobile genetic element [carbapenemase] that can make an enzyme, which makes carbapenem antibiotics ineffective and rapidly spreads resistance that destroys these important drugs.”
The new CDC population study used data obtained from eight U.S. metropolitan areas between January 2012 and December 2015.
The researchers found 1,499 CRE cases that included 149 (10%) that were community-associated (this means without hospitalization or the classic epidemiological risk factors of having invasive devices, such as catheters). Moreover, five of 12 community CRE isolates the CDC sequenced had the carbapenemase gene.
The incidence of CRE cases per 100,000 population was 2.96 overall and 0.29 community-acquired CRE. Compared to healthcare cases, community CRE most often involved Escherichia coli in urinary tract infections (UTIs). “These cases were more likely to occur in female persons of white race with few documented underlying conditions,” the authors concluded, speculating that those CRE UTIs likely would be given ineffective, empiric drugs.
- Bulens SN, Reses HE, Ansari UA, et al. Carbapenem-resistant enterobacterales in individuals with and without health care risk factors — Emerging infections program, United States, 2012-2015. Am J Infect Control 2022; May 25. doi: 10.1016/j.ajic.2022.04.003. [Online ahead of print].
- Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States 2019. https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf
