This document discusses "superbugs", which are bacteria that are resistant to antibiotics known as Carbapenem Resistant Enterobacteriaceae (CRE). Two deaths at a California medical center were linked to CRE after patients were exposed via contaminated medical instruments. CRE infections cause thousands of cases and deaths annually in the US. They are difficult to treat as the bacteria have become resistant to most available antibiotics. Prevention through hygienic practices by healthcare workers and attention to sterilizing instruments is important to avoid CRE becoming a widespread epidemic.

1. “SUPERBUG” INFECTION
Dr Jose Poulose

2. WHAT IS A SUPERBUG?
• Real name is Carbapenem Resistant Enterobacteriaceae.
• Reported from Ronald Reagan UCLA Medical Center, Los Angels, CA
• It is sometimes called “the nightmare bacteria”, as it does not respond to antibiotics.
• Probably more common than the number of reported cases.

3. SUPERBUG: WHAT DO WE KNOW SO
FAR?
• Two deaths at the California medical center are linked to the bacteria.
• Five other patients are infected and nearly 200 may have been exposed, the center
says.
• Exposure stemmed from two contaminated instruments used during procedures
done over the past few months at the facility.

4. INCIDENCE AND A CASE STUDY
• CRE causes an estimated 9300 cases per year and 600 deaths in the United States.
• A case was reported in Reno, Nevada. The patient was a 70 year old woman
returning from India. She was hospitalized in India two months before her return
due to complications from a femur fracture.
• This patient subsequently died as all the 26 available antibiotics were ineffective to
treat her. In spite of the best efforts by doctors, she developed septic shock and
multiorgan failure, resulting in her death.
• The saving grace-this patient was in a single room and did not cause exposure to
other patients!

5. ADDITIONAL POINTS
• CRE is in a family of bacteria that are normally found in the gut and have become
resistant to antibiotics.
• They are resistant to most of the available antibiotics.
• The devices linked with the UCLA outbreak, known as duodenoscopes, are used in
more than 500,000 procedures a year in the U.S., according to the CDC.

6. TWO TYPES OF CRE
• "There are two primary types of CRE.
• One of them is called New Delhi metallo-beta-lactamase, or NDM, and another one
is called Klebsiella pneumoniae carbapenemase, or KPC," as per Lei Chen, senior
epidemiologist for the Washoe County Health District.
• Both strains both have specific enzymes that can break down carbapenem
antibiotics, rendering these powerful drugs ineffective, explained Chen.
Generally, KPC is more prevalent in the US than NDM: The CDC recorded 175 NDM
cases as of January 6.

7. ADDITIONAL POINTS
• The problems can start when the bacteria leave the intestine and live in other areas,
such as the urinary tract, lungs, skin, and on medical equipment.
• The infection is caused when the body’s natural immunity breaks down.
• For the same reason, it is uncommon among healthy people.
• Seen among people living in Nursing Homes, Long Term care facilities and those
with prolonged hospitalizations.

8. INCIDENCE AND SEVERITY
• During the last decade, CRE infections have been reported in 42 states, according to
the CDC.
• About 4% of U.S. hospitals had at least one patient with a CRE infection in the first
half of 2012, as per CDC
• 18% of long-term acute care hospitals did.
• As Per CDC, 40-50% of the patients with the infection may die.

9. TREATMENT
• Doctors may try Carbapenem group of antibiotics.
• More than one antibiotic is needed at times.
• At this point of time, it is more of a trial and error method as well as standard
treatment for sepsis.

10. PREVENTION IS BETTER THAN CURE
• Hygienic precautions by Health Care Workers- Something as simple as washing the hands
with soap and water.
• Attention to sterile precautions of instruments.
• Decreased length of stay at the hospitals.
• Let us hope and pray that it will not become a mass epidemic.