Carbapenem-Resistant Enterobacteriaceae: A Call for Cultural Change
Authors: Tara N. Palmore, David K. Henderson
Journal: Annals of Internal Medicine (2014)

Ideas and Opinions15 April 2014Carbapenem-Resistant Enterobacteriaceae: A Call for Cultural ChangeTara N. Palmore, MD and David K. Henderson, MDTara N. Palmore, MDFrom National Institutes of Health Clinical Center, Bethesda, Maryland. and David K. Henderson, MDFrom National Institutes of Health Clinical Center, Bethesda, Maryland.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M13-1910 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Starting in the summer of 2011, a cluster of infections caused by carbapenem-resistant Enterobacteriaceae (CRE) occurred in the National Institutes of Health Clinical Center (NIHCC). Over 15 months, 18 patients acquired a single CRE strain and 7 highly immunocompromised patients died of CRE infection. Four patients’ bloodstream isolates became resistant to all antibiotics. Aggressive and costly implementation of multiple infection control interventions (Table) (1) ultimately controlled transmission. Carbapenem-resistant Enterobacteriaceae infections have become a major threat to health care facilities throughout the world and can be particularly devastating for immunosuppressed patients, with mortality rates exceeding 50% (1). Our experience with this ...References1. Centers for Disease Control and Prevention. Guidance for control of carbapenem-resistant Enterobacteriaceae (CRE): 2012 CRE toolkit. Washington, DC: U.S. Department of Health and Human Services; 2013. Accessed at www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf on 24 February 2014. Google Scholar2. Snitkin ES, Zelazny AM, Thomas PJ, Stock F, Henderson DK, Palmore TN, et al; NISC Comparative Sequencing Program Group. Tracking a hospital outbreak of carbapenem-resistant Klebsiella pneumoniae with whole-genome sequencing. Sci Transl Med. 2012;4:148ra116. [PMID: 22914622] CrossrefMedlineGoogle Scholar3. Semmelweis IP. Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers [The Etiology, Concept, and Prophylaxis of Childbed Fever]. Pest, Wein, und Leipzig, Germany: C.A. Hartleben's Verlags-Expedition; 1861. Google Scholar4. Holmes OW. Classic pages in obstetrics and gynecology. Oliver Wendell Holmes. The contagiousness of puerperal fever. The New England Quarterly Journal of Medicine and Surgery, vol. 1, pp. 503-530, 1842-1843. Am J Obstet Gynecol. 1974;119:852. [PMID: 4601465] MedlineGoogle Scholar5. Bálint P, Bálint G. [The Semmelweis-reflex]. Orv Hetil. 2009;150:1430. [PMID: 19592340] CrossrefMedlineGoogle Scholar6. Palmore TN, Michelin AV, Bordner M, Odom RT, Stock F, Sinaii N, et al. Use of adherence monitors as part of a team approach to control clonal spread of multidrug-resistant Acinetobacter baumannii in a research hospital. Infect Control Hosp Epidemiol. 2011;32:1166-72. [PMID: 22080654] CrossrefMedlineGoogle Scholar7. Diekema DJ, Pfaller MA. Rapid detection of antibiotic-resistant organism carriage for infection prevention. Clin Infect Dis. 2013;56:1614-20. [PMID: 23362298] CrossrefMedlineGoogle Scholar8. Tamma PD, Tan K, Nussenblatt VR, Turnbull AE, Carroll KC, Cosgrove SE. Can matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF) enhance antimicrobial stewardship efforts in the acute care setting? Infect Control Hosp Epidemiol. 2013;34:990-5. [PMID: 23917918] CrossrefMedlineGoogle Scholar9. Huang AM, Newton D, Kunapuli A, Gandhi TN, Washer LL, Isip J, et al. Impact of rapid organism identification via matrix-assisted laser desorption/ionization time-of-flight combined with antimicrobial stewardship team intervention in adult patients with bacteremia and candidemia. Clin Infect Dis. 2013;57:1237-45. [PMID: 23899684] CrossrefMedlineGoogle Scholar10. Boucher HW, Talbot GH, Benjamin DK, Bradley J, Guidos RJ, Jones RN, et al; Infectious Diseases Society of America. 10 x ‘20 Progress—development of new drugs active against gram-negative bacilli: an update from the Infectious Diseases Society of America. Clin Infect Dis. 2013;56:1685-94. [PMID: 23599308] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From National Institutes of Health Clinical Center, Bethesda, Maryland.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1910.Corresponding Author: David K. Henderson, MD, National Institutes of Health Clinical Center, Building 10, Room 6-1480, 10 Center Drive, Bethesda, MD 20892; e-mail, [email protected]gov.Current Author Addresses: Dr. Henderson: National Institutes of Health Clinical Center, Building 10, Room 6-1480, 10 Center Drive, Bethesda, MD 20892.Dr. Palmore: National Institutes of Health Clinical Center, Building 10, Room 12C103A, 10 Center Drive, MSC 1888, Bethesda, MD 20892.Author Contributions: Conception and design: D.K. Henderson.Analysis and interpretation of the data: D.K. Henderson.Drafting of the article: D.K. Henderson.Critical revision of the article for important intellectual content: T.N. Palmore, D.K. Henderson.Final approval of the article: T.N. Palmore, D.K. Henderson.Administrative, technical, or logistic support: D.K. Henderson.Collection and assembly of data: T.N. Palmore. 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