Advocate Lutheran Hospital: No patient deaths in CRE outbreak

January 12th, 2015

Responding to questions from Hospital Infection Control & Prevention, the hospital involved in a recent outbreak of carbapenem-resistant Enterobacteriaceae (CRE) reports that the infections were only susceptible to a few antibiotics but no patient deaths occurred.

The Centers for Disease Control and Prevention did not identify the hospital in question in reporting an outbreak of New Delhi metallo-β-lactamase producing Escherichia coli associated with endoscopic retrograde cholangiopancreatography (ERCP). The endoscopes used to perform ERCP were implicated in the outbreak, which subsided when the hospital went from high level disinfection to gas sterilization.

Though a request for a telephone interview was declined, Leo Kelly, MD, vice president of medical management for Advocate Lutheran General Hospital in Park Ridge, IL, provided a few brief answers to questions submitted by email by HIC.

HIC: The CDC reports that from March to July 2013, nine patients with positive cultures for NDM-producing E. coli (eight clinical cultures and one rectal surveillance culture) were identified. What were the symptoms of the patients that prompted these clinical cultures? Can you comment on the severity of these infections and the patient outcomes? Were there any deaths?

Kelly: “As with any patient that presents with signs of active infection, (i.e. fever, elevated white count, wound infection), a clinical workup is initiated to determine the underlying cause. All patients were treated and released from Lutheran General Hospital. To our knowledge, no deaths have occurred.”

HIC: Was the E. coli strain highly drug resistant or were you able to find antimicrobial options for treatment? If so, which drugs proved effective?

Kelly: “Yes, this organism is multi-drug resistant . Yes, there were some limited treatment options that were used, such as tigecycline and colistin, some patients also received an aminoglycoside, which proved to be effective.”

HIC: What level of isolation did you place the patients on and did any transmission occur that was not related to the contaminated endoscopes?

Kelly: “All patients identified with multi-drug resistant organisms are placed in contact isolation, based upon the CDC transmission-based guidelines. We found no evidence of any additional transmission.”

HIC: Have you been able to determine how the outbreak originated? For example, if you were able to determine the index case, was it in a person who recently traveled out of the country (i.e. India)?

Kelly: “This is still under investigation.”

HIC: The CDC reports you went from high level disinfection to gas sterilization, stopping the outbreak. Are you going to continue this sterilization approach going forward for the ERCP scopes? Based on your experience would you recommend that other hospitals using ERCP scopes adopt such stringent sterilization procedures?

Kelly: “At this time, we are continuing this process until further recommendations are made by the CDC or FDA.”

For more on this important story see the Feb. 2014 issue of HIC.