Closeup image of gloved hands spraying surface with disinfectant for infection control

Bacteria that cause drug-resistant infections often found in long-term care facilities appear to be spreading beyond the healthcare setting, according to a new study from the Centers for Disease Control and Prevention. 

Investigators analyzed data collected at eight U.S. sites from 2012 to 2015. Fully 10% of infections caused by carbapenem-resistant Enterobacterales (CRE) were community- rather than healthcare-associated. Most of the community-associated CRE cases were caused by the superbug Escherichia coli (E. coli) in urinary tract infections. And these infections, in turn, were more likely to occur in people with fewer underlying conditions than in LTCF residents or hospital patients, the researchers reported. 

The study results are troubling, experts say. CRE is predominantly associated with infections in high-acuity ventilator-capable LTCFs and other healthcare facilities. There, it is tracked and managed with infection control and prevention protocols. But out in the community, it will be much more difficult to control, according to the Center for Infectious Disease Research and Policy at the University of Minneapolis (CIDRAP).

Although the relative percentage of these community-occurring infections is small, the fact that these organisms are spreading among people without typical risk factors was surprising, CDC epidemiologist and lead study author Sandra Bulens, MPH, told CIDRAP News.

“These are typically organisms identified in individuals with extensive healthcare exposure,” she said. “Seeing this spread into the community is a concern because of the potential to cause infections that are challenging to treat in a broader population.”

APIC weighs in

Infection control experts have taken note of the study results.

“This study provides important initial data regarding the potential for CRE to become more common in the community,” said Linda Dickey, RN, MPH, 2022 president of the Association for Professionals in Infection Control and Epidemiology, in a statement. “It also reinforces the need for continued CRE monitoring outside of healthcare settings to inform community infection prevention efforts and reduce the spread of serious, drug-resistant infections.”

Full findings were published in the American Journal of Infection Control.

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