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March 29, 2011

Superbug frightening for frail patients in Calif.

By Lois M. Collins
Deseret Morning News

LOS ANGELES, Calif. — A "superbug" that outsmarts multiple types of antibiotics in the medical arsenal has infected more than 350 patients in Los Angeles-area facilities. And that has health officials nationwide worried. A study of the issue by the LA.

County Department of Public Health will be presented in Dallas next week at the annual meeting of the Society for Healthcare Epidemiology of America. ABC News reported this weekend that carbapenem-resistant Klebsiella pneumoniae, or CRKP, had been seen hundreds of times there between June and December of 2010. Most of the patients were elderly.

The report quoted study author Dr. Dawn Terashita, medical epidemiologist, as saying most of the patients were elderly, they were often on ventilators and they are apt to have been staying at a facility for a long time. The Centers for Disease Control and Prevention began tracking CRKP across the country in 2009. Officials there say it is harder to treat than MRSA, methicillin-resistant Staphylococcus aureus. It has also been confirmed in most of the states, including Utah, according to a map made by the CDC.

The CDC describes Klebsiella as a type of gram-negative bacteria that normally is found living harmlessly in human intestines. It can cause a variety of infections, most of them associated with healthcare settings, including pneumonia, bloodstream infections, wound or surgery-site infections and meningitis. That's determined by how it enters a patient, so infection gained through respiration becomes pneumonia, while that in a wound becomes a bloodstream infection, for example.

So-called "superbugs" occur when bacteria mutate to the point that antibiotics previously effective against them no longer are. "Superbug" and "multiresistant" are sometimes used interchangeably. The ABC report emphasizes that healthy people are not endangered by the bacteria, but said it can be lethal to those who are ill or frail. Months ago, the superbug was found in New York City, where researchers at the Columbia University Medical Center said 42 percent of the infected patients, half of them solid-organ transplant recipients, died within a month after being infected.

It noted that how sick they were, how quick the response was to tackle the infection and source control all had an impact on how well the patient weathered the superbug's attack. Medscape says that CRKP has now spread to all Israeli hospitals, as well, despite infection-control measures.

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