Lessons unlearned: Gram neg bugs conquer continuum

January 12th, 2015

Emerging multidrug resistant gram negative bacteria are spreading across the health care continuum, becoming entrenched in non-acute and long term care settings and threatening vulnerable hospital patients with untreatable infections, epidemiologists reported recently in Dallas at the annual conference of the Society for Healthcare Epidemiology of America (SHEA).

Of course established heavyweights like Clostridium difficile and MRSA are still very much a concern, but multidrug resistant (MDR) gram negative rods like carbapenem-resistant Klebsiella pneumoniae (CRKP) and Acinetobacter baumannii (MDR-Ab) are a whole new threat. These pathogens are capable of pan-resistance, there are few drug options in any case, resistance-empowering plasmids can transfer among species, and infection mortality rates in the 40% range have been reported in vulnerable patient populations.

Not exactly what you want moving through the health care continuum, but that appears to be what’s happening in a situation that could get considerably worse before it gets better. In the lessons unlearned category, we are reminded of the vancomycin resistant enterococi (VRE) outbreaks in the 1990s, when communication breakdowns between hospitals, nursing homes and other non-acute settings descended into accusations of who gave what to whom.

“We spend a lot of time blaming each other,” said Jon Furuno, PhD, an assistant professor of epidemiology and public health at the University of Maryland School of Medicine in Baltimore. “If you talk to any nursing home administrator they will say that their infection control problems are primarily related to transferring residents to acute care. [Residents] come back colonized or infected with some resistant organism.”

On the other hand, he told SHEA attendees, “If you talk to hospital medical directors and infection control, they tell you these nursing home patients are `cesspools’ of resistance and they spread it all over the hospital. The bad thing is that they are both right. We have to figure out how we are going to work together.”

For more of this story and other SHEA coverage see the May 2011 issue of Hospital Infection Control & Prevention