The rise of superbugs sounds like something out of a sci-fi movie, but as we know all too well, the problem is real. The bacteria are called superbugs — because they can make people very sick or kill them. They are resistant to antibiotics and have become a constant threat in our hospitals, with MRSA (methicillin-resistant Staphylococcus aureus) is the best-known. Now a different superbug has invaded our nursing homes and other health-care facilities, notably in Los Angeles but also in 35 states besides California. This bug, called carbapenem-resistant Klebsiella pneumoniae (CRKP), lives on equipment such as ventilators and catheters. While most healthy people are not at risk for infection, the bug can easily be carried on your hands or clothing and then transmitted it to those who are frail, elderly or otherwise vulnerable.
People At Risk
A recent study from the LA County Department of Public Health showed that between June and December 2010, about 350 cases of CRKP were reported in LA County alone. Another 2010 study, from Columbia University Medical Center in New York City, revealed that 42% of affected patients died within 30 days of infection. I checked in with Philip M. Tierno, Jr., PhD, director of clinical microbiology and immunology at New York University’s Langone Medical Center in New York City, to talk about exactly how bad the “bug” appears to be.
Dr. Tierno says that sometimes the CRKP infection is so bad that it can kill the patient outright and sometimes the CRKP is the co-cause of death. This infection most often presents itself as pneumonia, but sometimes as meningitis, urinary tract or blood and wound infections that are difficult to clear. He told me that he had heard experts calling CRKP very, very serious. They describe the bug, which belongs to the same family of bacteria as salmonella and E. coli, as even more difficult to treat than MRSA.
How then to prevent a CRKP infection? Dr. Tierno says that in addition to people in hospitals or nursing homes, those most at risk include people who are immunologically compromised because of extended hospital stays, those who have HIV or other chronic diseases that affect immunity — and certainly transplant patients who must take drugs to suppress immunity. People who are on lengthy antibiotic therapy are at very high risk, he says, because the antibiotics suppress and partially kill off less hardy bacteria, leaving stronger, more dangerous ones to survive and dominate. In fact, many of the geriatric patients who developed CRKP infections had recently been on antibiotics.
What You Can Do
Dr. Tierno said that in general, health-care facilities today are working hard to sanitize equipment and the environment to bring the infection rate down to “near zero.” But he makes very clear that one of the best protections your loved one can have is actually you. Here are the guidelines he gave me…
- Make yourself the germ monitor in the care facility. Health-care staff can and do spread germs from patient to patient, be vigilant. “Speak up,” says Dr. Tierno. Staff members must wash their hands or cleanse them with an alcohol-based gel when entering a patient’s room. Instruments such as stethoscopes must be kept germ-free as well. Embarrassed to say something? Don’t be, says Dr. Tierno. In fact in his hospital, identification badges include this query under staff names: “Are my hands clean? Ask me.” This is the attitude the public must adopt, he says, because it may well be what keeps patients alive.
- Avoid becoming a low-level carrier of the CRKP bug. About 80% of infectious disease is transmitted by direct contact between an infected person and an uninfected person — through coughing, talking (which lets vapor out of your lungs), kissing — or indirect contact, such as when an infected person touches a doorknob and then an uninfected person reaches for the same knob. (The remaining 20% of infections are airborne or are transmitted through sources like food and water.)
To shield yourself from becoming a carrier (and then infecting someone else), wash your hands regularly, especially before you touch your eyes, nose or mouth. Also, to protect yourself, keep any wounds you have clean and avoid touching them.
- If you must take an antibiotic, speak to your doctor about taking a probiotic as well in order to keep your “good bacteria” strong and able to fight off an invasion of “bad bacteria.”
Dr. Tierno adds that there is currently limited success fighting CRKP with certain antibiotics such as tigecycline (Tygacil), other drugs containing colistin, an older antibiotic that can cause kidney damage, and various combinations of drugs. Should someone you know become infected, such drug therapies will certainly be tried. Nevertheless, there is nothing on the horizon at this time that has real promise for successfully treating CRKP, and so the best approach continues to be a good defense.