“Superbugs” Called CRE
You may have heard the term “superbug” discussed in the media lately. The recent “superbugs” are actually called Carbapenem-Resistant Enterobacteriaceae, or more simply, CRE. The reason these bacteria are so dangerous is because they are resistant to most antibiotics, making them very difficult to treat.
Normally, the antibiotic sensitive strains of these bacteria live in our gut, but can spread to other parts of the body causing urinary tract infections, blood stream infections, wound infections, and pneumonia. In the case of CRE, these bacteria have picked up extra genetic material, making them resistant to a powerful group of antibiotics called carbapenems. This resistance lets the bacteria live and reproduce in the presence of an antibiotic that would normally kill them. CRE infections can be very difficult to treat because there are few antibiotics that can effectively treat them.
Why “Superbugs” Are in the Media Now
Recently, several hospitals across the country have faced scrutiny in the media related to transmission of CRE from contaminated endoscopes used during a procedure called ERCP (Endoscopic Retrograde Cholangiopancreatography)1. This national outbreak is limited to ERCP scopes and has not been shown to occur with other scopes used to examine the colon, lungs, or bladder.
In many cases, the ERCP scopes were cleaned and disinfected by trained staff according to the manufacturer’s recommendation. One part of the scope, called the elevator, can remain contaminated even after cleaning. Consequently, despite appropriate cleaning and disinfecting, bacteria can persist on the elevator and be passed on to the next patient having an endoscopic procedure.
What Intermountain Is Doing
To date, no CRE infections have been detected following ERCP procedures in any of our facilities. We noted the concerns with endoscope cleaning early in the outbreak and are in the process of a thorough assessment. We have assembled a team of infection preventionists, endoscopy staff, microbiologists, and infectious diseases specialists to ensure that our procedures to clean and disinfect these scopes are effective and minimize risk to our patients.
The Centers for Disease Control and Prevention and Food and Drug Administration have announced new endoscope cleaning and disinfecting guidelines as a response to this issue2,3. We will be using these guidelines to ensure our endoscopes are cleaned, disinfected, and monitored accordingly.