Ronald Reagan UCLA Medical Center is assuring the public that the hospital is taking all precautionary measures to protect patients against the so-called "superbug" bacteria that's infected seven patients. Two patients have died and the hospital says it's notifying 179 others who may have been infected.
Known as Carbapenem-resistant Enterobacteriaceae - or CRE for short - the bacteria was reportedly transmitted between October and January during endoscopic procedures that use a particular kind of device known as a "duodenoscope."
These are devices that are threaded down the throat to diagnose and treat certain cancers, gallstones and other digestive disorders.
Where did this superbug come from?
CRE is a naturally occurring bacteria. It's part of the same family of bacteria as Escherichia coli (E. coli) and is found in human intestines.
Normally, these bugs don't cause trouble. But, when they're somehow transmitted to other parts of the body - such as the blood or other organs - the bacteria can cause serious infections and death.
How did CRE become a superbug?
Natural evolution is one way. It can make bacteria resistant to a single antibiotic, says Arjun Srinivasan of the Centers for Disease Control and Prevention (CDC).
However, he says, they also gain strength every time a patient takes an antibiotic. That's because antibiotics work by killing vulnerable bugs and leaving heartier ones alive. Over time, this leads to stronger and stronger bacteria that may can become resistant to many different treatments.
"When we use, and in many instances, overuse antibiotics, we are adding fuel to the fire of the bacteria developing resistance," Srinivasan noted.
How exactly does a superbug resist antibiotics?
Bacteria can use many different tools to fight off an antibiotic. Typically, an antibiotic will disrupt some vital function of a bacteria cell. Sometimes that means it will attack the cell wall, causing the bug to leak out its insides. Other times, it will prevent the bacteria from reproducing.
CRE fights back with a powerful enzyme it possesses that can deactivate an antibiotic. Srinivasan describes it as "chewing up" the antibiotic. He says some strains of CRE seem immune to all known antibiotics.
Where did the CRE outbreak at UCLA come from?
This current infection at UCLA has been traced to two scopes that had a CRE infection embedded in them, according to UCLA officials. The two scopes were used in the initial case and in seven subsequent patients who were also infected with the bacteria.
How does CRE get embedded in a device?
The scopes in question are hard to clean, says Alex Kallen, medical officer for the CDC's Division of Healthcare Quality Promotion.
"The tips of these scopes are very intricate pieces of equipment, with lots of very small and intricate moving parts," Kallen says. If disinfectant doesn't get into all the device's nooks and crannies, he says, bacteria "could potentially be passed to the next person that’s exposed to the scope."
Los Angeles County health officials say there were no breaks or breaches in how UCLA was cleaning these scopes. Since January 28, 2015, hospital officials say UCLA has also started using gas sterilization to clean the devices. This is an extra step that goes beyond recommendations from the Food and Drug Administration (FDA) and from the manufacturer, Olympus Medical Systems Group.
How do I know if one of these scopes was used on me?
UCLA says it's notified – via mail and telephone – all 179 patients who were examined with one of the contaminated instruments between October 3 and January 28.
Those patients are being offered a free home testing kit for analysis at UCLA, to determine if they’re carrying the bacteria in their intestines, hospital officials say.
What if I do test positive for CRE?
Most people who acquire CRE will eventually clear the bacteria from their colon, if they are not exposed to antibiotics, according to UCLA.
But it's important for patients to know that if their colonized with the bacteria, their health care workers may be required to treat them differently than they do other patients, in case an infection does exist. For instance, UCLA says it will ask health care workers to wear gowns and gloves if a patient is a CRE carrier and is admitted to the hospital.
There's no reliable way to eradicate CRE from the colon, though it's likely that, over time, it will be crowded out by other bacterial strains that do not have antibacterial resistance, according to the hospital.
Are there other types of scopes that have similar problems?
Yes. CRE can enter the body through other types of medical devices, like ventilators, intravenous catheters, urinary catheters, or wounds caused by injury or surgery, according to the CDC.
I'm undergoing surgery soon. Should I be worried?
Whenever you go to the hospital, there's always a risk for infections - especially if you are going to have any kind of surgical procedure. If you are concerned about this and are having an endoscopic procedure, be sure to share your concerns with your doctor.
“We are working hard with other specialty societies and manufacturers and the FDA to think about ways to make these scope as safe as possible for the small number of people who have to have them,” the CDC's Kallen says. "These are life saving procedures for some people. If they don’t have these, they may end up having more aggressive invasive procedures that could put them at risk for other things such as surgery."
How can I protect myself from this type of infection?
The CDC offers tips, including:
- Tell your doctor if you’ve been hospitalized in another facility or country
- Take antibiotics only as prescribed
- Insist that everyone wash their hands before touching you