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Lethal superbugs detected in nearly half of Mass. hospitals

Patients infected with a particularly lethal and hard-to-treat type of bacteria have been treated in nearly half of Massachusetts hospitals, according to a report to be released today.

The first statewide audit to track these fast-spreading superbugs found the drug-resistant bacteria known as CRE in 31 of the 63 hospitals that responded to a survey.

“It’s across all regions of the state, and it’s not just concentrated in Boston,’’ said Dr. Evangeline Thibodeau, an infectious disease physician at Tufts Medical Center who led the study. “It’s a problem for everybody.’’

CRE infections have spread worldwide over the past decade, with one bacterium in particular the most prolific, Klebsiella pneumoniae. The germ has been detected in at least 35 states and is known for its ability to outsmart a class of antibiotics that disease specialists reserve for patients with the toughest infections.


Formally known as Carbapenem-resistant Enterobacteriaceae, the germs can easily be spread from one hospitalized patient to another by caregivers who have neglected to wash their hands or by contact with contaminated surfaces.

They are not spread through the air. Frail and elderly hospitalized patients are typically the most vulnerable.

The study didn’t track how many of the CRE-infected patients died, but the authors noted that such patients are three times more likely to die than those with similar infections that still respond to the main antibiotics.

CRE’s global spread comes as the pipeline of drugs in development to vanquish these bugs is drying up, and health care providers are increasingly reporting shortages of older medicines that have proven effective against CRE but are more toxic.

Infected patients in Massachusetts were more likely to be treated in large teaching facilities, with 75 percent of academic hospitals reporting cases of CRE, according to the survey conducted by researchers from Tufts, Lahey Clinic, and the state Department of Public Health.


The report is being presented at the annual meeting of the Infectious Diseases Society of America.

Smaller facilities are not immune. The survey revealed that 46 percent of nonteaching hospitals have also treated patients with CRE infections.

The survey, conducted between November 2010 and February, asked about all types of CRE infections, not just Klebsiella pneumoniae.

The survey also asked hospitals about the methods they used to detect CRE infections, and researchers found that many are following old guidelines and using inconsistent systems, which could lead to missed cases. Only one hospital was found to be using the current industry-recommended method.

The researchers did not identify any of the hospitals in the survey.

“They were all over the board in testing,’’ Thibodeau said, which led researchers to conclude that their findings are probably an underestimate of the numbers of Massachusetts hospitals in which CRE infections have been detected.

Specialists believe that overuse and incorrect prescribing of antibiotics have fueled the growth of these superbugs.

Dr. Alfred DeMaria, the public health department’s chief disease tracker, said the wide prevalence of CRE indicated by the report shows the need for a more focused battle plan, especially because elderly patients are frequently moved between hospitals and nursing homes, which could further spread the infections.

“We need to do more because these bugs are smarter than we are in some ways,’’ he said.

DeMaria said that, among other actions, the department is stepping up training for health care providers to help ease the overuse of antibiotics.


In another study being presented at the meeting, about 78 percent of infectious disease specialists recently surveyed nationwide said they had to modify their choice when prescribing antibiotics because of drug shortages.

Among the antibiotics reported to be in short supply are some of the precious few that can treat CRE infections.

Fifty-two percent of those surveyed said the resulting change in treatment because of a shortage adversely affected their patients, often because they had to switch to a more toxic substitute. More than a quarter said the changes resulted in sicker patients and longer hospitalizations.

“These are drug shortages that healthy people don’t have to worry about, but if grandma gets admitted to the hospital and has a serious infection, this is very worrying,’’ said Susan Beekmann, a registered nurse at the University of Iowa Carver College of Medicine and a coauthor of the study.

Among the hospitals that have faced shortages of drugs to treat CRE infections is Massachusetts General.

“It’s often been ones that are off-patent, and one would have thought they would have been available from generic manufacturers,’’ said Dr. David Hooper, chief of infection control at Mass. General.

Hooper said the hospital, which has reported CRE infections, follows federal guidelines to halt the spread, including isolating infected patients in private rooms. He said the hospital has been “on the lookout’’ for CRE infections.

“We track them very carefully,’’ Hooper said, “to make sure that we are not seeing any patterns of increasing cases over time.’’


Kay Lazar can be reached at klazar@globe.com. Follow her on Twitter @GlobeKayLazar.