by Karen Blum, May 2013
Via: anesthesiologynews.com {click for full story}
Hospital pharmacists face several challenges in helping manage antibiotic-resistant, gram-negative superbugs that produce carbapenemases. One of the most worrisome is carbapenemase-producing Klebsiella pneumoniae (KPC).
A report in the March issue of Infection Control and Hospital Epidemiology (2013;34:259-268) found that the proportion of K. pneumoniae cases resistant to carbapenems increased from 0.1% in 2001 to 4.5% in 2010. “That is huge,” said Robert Rapp, PharmD, emeritus professor of pharmacy and surgery at the University of Kentucky Medical Center in Lexington, who is one of many pharmacists concerned about KPC infection.
Those concerns were compounded by a Centers for Disease Control and Prevention (CDC) report on the rising prevalence of carbapenem-resistant enterobacteriaceae (CRE). According to the report, in the last decade, hospitals have seen a fourfold increase in CRE, with most of the increase attributable to Klebsiella species (MMWR 2013;62:1-6).
The fact that these superbugs are making their presence most felt in hospitals is not surprising: In healthy patients, KPC may colonize the intestines without causing disease, but in patients whose immune system is impaired, it can turn deadly. KPC can spread through human-to-human contact and has been found to live on equipment such as catheters. In the past, K. pneumoniaetypically had been treated with cephalosporins or carbapenem antibiotics, but the bacteria are becoming increasingly resistant. Thus, drugs such as colistin, polymyxin B and tigecyline are not always effective alone, so they have to be combined. “But there’s no real, solid data on the drugs of choice,” Dr. Rapp noted, and medical staff “are just kind of flying by the seat of their pants.”
With no new antibiotics in the pipeline, “we really have a problem,” he stressed. “If you come down with one of these
KPC is “definitely something that’s on our radar,” said Claudine El-Beyrouty, PharmD, BCPS, an infectious disease pharmacist at Thomas Jefferson University Hospital, in Philadelphia. KPC most often is found among critically ill patients hospitalized for extended stays or in patients who go in and out of the hospital frequently, she said. At this point, most hospitals in the Northeast region of the country have encountered it, according to Dr. El-Beyrouty. At Jefferson, several patients per quarter carry the organism or show signs of being infected, she noted.
The hospital manages the infections through a multitiered approach, Dr. El-Beyrouty said. Infection control personnel track cases; once the organism is detected in a patient, the person is isolated and the chart is flagged. If the patient is discharged and later returns, the flag is reactivated and the person is isolated again. Caregivers treating these patients wear gowns and gloves and employ handwashing techniques. Pharmacists participating in the hospital’s antibiotic stewardship program try to reserve agents like colistin, tigecycline and amikacin specifically for KPC patients.