Superbug at LA hospital linked to two deaths and 179 potential infections

http://www.theguardian.com/us-news/2015/feb/19/superbug-ronald-reagan-ucla-hospital-los-angeles

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Antibiotic-resistant bacteria could have infected at least 179 patients at the Ronald Reagan UCLA medical center in Los Angeles, and were a “contributing factor” in the deaths of two people, after patients underwent a complex endoscopy procedure with infected medical devices.

“We notified all patients who had this type of procedure, and we were using seven different scopes. Only two of them were found to be infected. In an abundance of caution, we notified everybody,” university spokesperson Dale Tate told the Associated Press and NPR News.

Carbapenem-resistant enterobacteriaceae, called “CRE” by medical professionals, is especially nasty. The two-part name refers first to the antibiotic such bacteria resist, carbapenem, and second to where they live, in the human gut.

Carbapenem is one of medicine’s strongest antibiotics, often called “an antibiotic of last resort” and given to patients who are “gravely ill or are suspected of harboring resistant bacteria”, according to research by the National Hospital Safety Network.

CRE usually infects patients who are already ill – for example, those in long-term or intensive care units. It is typically spread from person to person, in this case during an endoscopic procedure. Antibiotic-resistant bacteria can cause everything from urinary tract to bloodstream infections and are deadly in as many as half of people infected, according to the Centers for Disease Control and Prevention (CDC).

The procedure that infected patients at UCLA was an endoscopic retrograde cholangiopancreatography (ERCP), in which a flexible tool is inserted down the throat and into the stomach. ERCP combines an x-ray and endoscopy to treat and diagnose gastrointestinal problems such as gallstones.

Tate told the Los Angeles Times the UCLA hospital had updated its instrument-cleaning procedures since the endoscopes came under suspicion of spreading the disease. Tate said the hospital was following manufacturers’ instructions to clean the instruments before the infections were spread. Two scopes are believed to have been infected, and both have been removed, according to the LA Times.

UCLA has had brushes with patient-safety critics before. In 2012, the influential healthcare thinktank Leapfrog Group called the hospital’s safety record “less than outstanding”.

Scores have since improved, but UCLA’s hospital-acquired condition indicators ranked only second out of four in Leapfrog’s most recent survey. The hospital showed “some progress”, the second-lowest possible measure, one step above “willing to report”.

The ERCP procedure has been suspected in previous outbreaks of CRE. Between 2012 and 2014, 32 Seattle patients were infected with CRE when receiving ERCP.

The National Institutes of Health reports one of the procedure’s top risks as infection; complications that require a hospital stay can occur in up to 10% of patients.

Exactly how many hospitals have been affected by such outbreaks is difficult to determine. In January 2014 at Advocate Lutheran General Hospital in Park Ridge, Illinois, more than 40 people were infected by CRE. Eight patients were infected at a Denver hospital in 2012.

Researchers have called antibiotic-resistant bacteria an “ongoing and increasing challenge to hospitals”, but there is no requirement for hospitals to alert the CDC to such infections.

Instead, the CDC monitors outbreaks through two programs. The first is the Emerging Infection Program, which monitors “10 sites across the country to determine which patients and community members have or are at risk for CRE”. The second program tracks hospital-acquired infections of all kinds through the the National Hospital Safety Network.