ses of a dangerous superbug increased 27 percent last year in a region surrounding Chicago, a new survey shows, but incidents were down in the city, and officials say they are making strides in containing the contagion.
The state survey counted medical patients who tested positive for a germ known as CRE, short for carbapenem-resistant Enterobacteriaceae, which withstands many of the strongest antibiotics. It generally strikes at health-care facilities, often among the elderly and people who have serious illnesses or have had invasive medical procedures.
CRE is relatively rare, but the director of the U.S. Centers for Disease Control and Prevention has called it a “nightmare bacteria” because it spreads easily, in some cases is impossible to cure and can kill up to half of its infected victims. That’s why the CDC is trying to stop its spread before it becomes more common.
The Chicago area, which in 2013 was the site of one of the largest outbreaks of CRE in the nation, has since become a leading model for how to limit the spread of the deadly infections, said Dr. Alexander Kallen, a CDC epidemiologist.
“Illinois is one of, if not the, national leader in these kind of prevention efforts,” Kallen said. “They’ve done incredible work and been an example to other states.”
Foremost among the state’s efforts was a program that cut CRE rates in half at four long-term acute care hospitals. The CDC awarded a $10 million grant this summer to Rush University Medical Center in Chicago and the Chicago Department of Public Health to build on that success, and the program is being expanded to more facilities, officials said.
Federal officials estimate there are 9,000 cases of CRE a year, and 600 deaths, but those are very general estimates based on small samples. Through the Detect and Protect program implemented in Illinois and 28 other states, the CDC is providing funding so that all state labs can detect various strains of CRE and report more precise data in the next year.
CRE was first reported in the United States in 2001, but concern about it rose after an outbreak in 2013 infected at least 39 patients at Advocate Lutheran General Hospital in Park Ridge, killing two. Authorities traced the cause to duodenoscopes, instruments inserted through the mouth to probe and clear blockages in the digestive system.
Officials found that the scopes were very difficult to clean following standard procedures, so Lutheran General began sterilizing the instruments with a gas that’s toxic to the bacteria. Since then, hospital officials said, they have had no further cases related to the outbreak strain, and have worked with a state CRE task force to address the issue.
n 2014, the state instituted a registry of extremely drug-resistant organisms like CRE, that tracks all positive lab tests for the germs. About 120 health-care facilities participated in the registry as of last year, allowing them to receive alerts when an infected patient is transferred in.
Statewide, the number of cases increased about 7 percent last year to 1,585, according to Illinois Department of Public Health figures. The state does not track outcomes of those cases, so it’s not known how many patients died. Some may carry the bacteria but are not infected and have no symptoms.
The 27 percent increase, from 2014 to 2015, came from a region surrounding Chicago that includes suburban Cook County, the collar counties and adjacent rural counties. The number of reported cases increased from 579 to 737.
Those increases may in part be the result of better reporting, with more facilities improving their identification and tracking of such bugs, said Melaney Arnold, a spokeswoman for the state public health department. The rate of cases overall remained about the same.
The state is helping hospitals to institute CDC guidelines to prevent the spread of the organism. That includes identifying high-risk patients, testing them and isolating them from other patients if necessary. Basic infection control precautions include having workers wear gowns and gloves and bathing patients in a 2 percent solution of antiseptic to reduce any bacteria on their skin.
One of the foremost authorities on CRE, Dr. Mary Hayden, of Rush, is co-principal investigator of the Chicago Prevention and Intervention Epicenter, which helps guide health-care facilities on how to prevent CRE. She said the group plans to expand its interventions in about 15 long-term acute care facilities, where the problem is most common, and 24 acute care hospitals.
“CRE patients tend to be some of the sickest of the sick,” Hayden said. “They might have stayed in the intensive care unit for months trying to wean off a ventilator, or have really severe wounds that need months to heal.”
It’s especially important to keep the infection away from vulnerable patients, including those with weakened immune systems such as chemotherapy patients and bone marrow transplant recipients.
At the University of Illinois College of Medicine at Chicago, another important part of the prevention program is antibiotic stewardship, Dr. Susan Bleasdale said. That means using the drugs only when necessary and only for as long as necessary to discourage the growth of resistant bacteria.
The biggest challenge, she said, is treating patients who can’t be cured by antibiotics that have stopped the spread of so many diseases in the past century.
“It’s difficult, it’s complicated,” she said of such cases. “It’s frustrating.”