The Centers for Disease Control (CDC) recently released guidance for aggressive infection control to combat the new emerging nosocomial pathogen known as CRKP. Carbapenem-Resistant Klebsiella pneumoniae is probably best known for an outbreak in Israel a few of years ago within the healthcare system there. It is one of many carbapenem-resistant Enterobacteriaceae (CRE) that is within the scope of the announcement.
The true extent and prevalence of this resistant strain within the environment is currently unknown, but it is more common than once thought. The mortality rate can only be guessed because of the relatively low number of known infection cases. The death rate has been observed within a range of 12.5% to as high as 44%. The number for a possible large outbreak in the future has been modeled and predicted for, but there is a rather large level of uncertainty. Regardless, the potential danger is serious.
These rates of morbidity and mortality for CRKP are particularly high. They suggest immediate action is required to respond to the potential threat. Previous patterns of secondary infection within the healthcare system, especially among the critically ill patients with prolonged hospitalization, or those expose to invasive devices (for example ventilators or central venous catheters), force us to error on the side of caution.
Effective sterilization and decontamination procedures are important to keep the infection rate of this antibiotic resistant bacterium as low as possible. Klebsiella pneumoniae are gram negative bacteria that can cause pneumonia, bloodstream infections, wound or surgical site infections, and meningitis in patients being treated for other illnesses or conditions.
The antibiotic resistant strain has minimal inhibitor concentrations (MICS) that are elevated. Yet, the levels do indicate that there is still susceptibility to some antibiotics. The concern is that carbapenem is often looked upon as a drug of last resort when battling resistant strains. This suggests that new slight mutations could result in infections for which there is very little if anything healthcare professionals can do to treat. There are already strains of CRE that actually produce the enzyme carbapenemase themselves, and therefore are listed amongst these other dangerous species.
CDC Focuses Upon Healthcare In U.S.
One of the main reasons for issuing the guidance is that CRKP is the most common CRE species encountered within the United States. In other words, the relevant bug has truly gone international. The spread must be slowed or stopped. This depends upon the implementation of comprehensive infection control strategies that not only serve to identify its mode of movement within the population, but also isolate it and properly sterilize any equipment or areas affected.
Another reason for the alert is that sharing of certain instruments in a hospital setting has been proven to sometimes occur. The FDA is working in concert with the CDC on this issue because hepatitis has recently been spread through sharing of insulin pens. Since ventilators and catheters are a couple of many known points for possible transmission of CRKP, sterilization of any equipment potentially used on multiple patients must be handled with care. This latest CDC advice focuses professionals to keep actual hygiene practices up that meet with already published standards. Potential human error still remains the biggest problem that needs to be consistently overcome.
Many of the affected pieces of equipment are normally sterilized using a chemical agent autoclave. Ethylene oxide is most commonly used type of dangerous gas for such sterilization purposes. Depending upon specific needs, safer alternatives might be possible. A free report is available to help with making any final decision.