Friday, March 8, 2013

Jane, antibiotics, and CRE

While I often alternate between finance and medical posts, based on some recent news, I went for a medical post.

Perhaps you have been reading the scary articles about CRE (carbapenem-resistant Enterobacteriaceae)? If you haven't, just search 'CRE superbug' and hear the doom and gloom for yourself. Basically, these awful suckers are found in hospital. They have been stealing resistence coding genes from other bacteria previously treated with antibiotics and are now resistant to our last line of defense antibiotics - carbapenems. The antibiotics also kill off the non-resistent competing bacteria giving these bad guys free reign in a patient. Half of the patients who get the infections will die because no antibiotics can treat them.  The bacteria are currently found exclusively in healthcare facilities . . . for now. . .

Freaked out? Wondering what you can do to protect yourself?
  • Wash your hands constantly while visiting a hospital. Touch something, cough on something, get coughed on - wash your hands. Try to keep from bringing as few germs as possible home from the hospital. Make sure everyone, including your doctor, nurse, tech, and housekeeping staff do the same.
  • Minimize your use of antibiotics. You probably don't have CRE, but the more 'normal' bacteria you keep around, the less resistant bacteria you are carrying. Many illnesses are actually viral and antibiotics will do nothing except kill of the innocent bystander bacteria.
  • Avoid visiting immunocompromised/elderly people while you are sick. They are the most vulnerable and constantly exposed to more antibiotics and germs. If a patient on chemotherapy gets a cold and fever, they may get treated with antibiotics. Even if it's probably just a virus, they can't take the chance it could be bacterial. An untreated bacterial infection in a patient with no white blood cells to fight it is almost always fatal.
There are plenty of times you will need antibiotics, but give all things time to show virus versus bacterial. Colds actually last 2 weeks, not 1 like people think they will. Antibiotics don't benefit people who have the flu virus. (Techinically, the flu virus softens people up for secondary bacterial pneumonia which is typically treated with antibiotics - in the ICU, on a ventilator, not the majority of flu cases)

Don't worry, in the future, I'll be writing a post on how I cope as a doctor knowing about all the killer germs out there. Hint - my kids eat dirt at non-hospital places.


  1. This is an interesting read. I'm currently in my 2nd year and just learning about the resistant bacteria just makes me wonder why doctors are prescribing meds too liberally especially when we know that bacteria and viruses can develop resistance to these drugs. Whats going to happen to us if everything that makes us sick becomes resistant to the drugs that are suppose to make us better?

    As you mentioned, hand washing is key. Even though it is common sense, there are people out there who do not wash their hands. Ick! Another thing that I do when I visit people at the hospital, is wear a face mask. It may seem silly but immunocompromised people don't need germs from us and the outside world getting into their system.

    Thanks for the informative post!

  2. Wait till you do your out patient rotations. Patients, as it turns out, don't like being sick and often want antibiotics. If you have a busy practice, you may find yourself prescribing antibiotics just because you don't have time to convince people they don' t need them. (Besides, they'll leave your office, they'll just head down the the urgent care next door and get their antibiotics there)

    BTW, viruses don't become resistant nearly as easily as bacteria, but it doesn't matter because most of our antiviral meds are pretty lame anyway compared to how effective antibiotics can be.