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A superbug that has plagued other parts of the world has made it to Nebraska.
One patient in the Omaha area has tested positive for the bacteria Klebsiella pneumoniae, which is resistant to a highly potent class of antibiotics and can cause several types of infections and, in some cases, death.
Doctors have few treatment options when even the strongest drugs don't kill the bacteria, so a Creighton University researcher is calling for more awareness of the threat and preventive action by health care providers.
The concern is that in a health care setting, the organism could spread to other patients, said Nancy Hanson, a professor in Creighton's Department of Medical Microbiology and Immunology. If doctors know that a patient has an antibiotic-resistant infection, she said, they could take steps to isolate the patient so the infection doesn't spread.
Klebsiella is a type of bacteria that can cause different types of infections, including pneumonia, bloodstream infections, wound or surgical site infections and meningitis, according to the U.S. Centers for Disease Control and Prevention. Klebsiella bacteria normally are found in humans' intestines, where they don't cause disease, the CDC says, and in human feces.
Regular hand-washing, therefore, is key.
The antibiotic-resistant bacteria have been reported in most other states besides Nebraska, but they have shown up most frequently in areas such as the northeastern United States, Israel, Colombia and Greece. New York City and Chicago each have reported hundreds of cases.
In the Nebraska person's case, Hanson said, the infection could have been acquired outside a hospital setting.
Dr. Tom Safranek, the Nebraska state epidemiologist, was informed Wednesday about the bacteria, a state spokeswoman said, and staff members are following up on the report.
The resistant bacteria first was reported in the U.S. in the early 2000s, said Dr. Alex Kallen, a CDC medical officer. “Since that time, it has spread slowly but surely across the country.”
The mortality rate associated with the bacteria is very high, Kallen said. “If you get an invasive infection with these bacteria, a bloodstream infection or something like that,” he said, “then the mortality rates have been reported to be over 40 percent or so.”
The incidence of the organisms in hospitals is relatively low, Kallen said. It's highest, he said, in long-term care centers.
The bug generally is spread person to person by shared equipment such as blood-pressure cuffs or stethoscopes or by health care personnel who get it on their hands or clothes.
The American Health Care Association, which represents more than 10,000 long-term care centers across the country, distributed information about the bacteria to its members this spring, said Greg Crist, an association spokesman. The group also dedicated a website page to information about the bacteria and included links to CDC information.
“You need a heightened level of awareness and alertness” when dealing with such bugs, Crist said. “We feel pretty confident about our protocols and our procedures in our centers.”
In addition to proper hand-washing, Kallen recommended that health care providers take these precautions to prevent the spread of the bug:
• Use gowns and gloves when caring for patients with the bacteria.
• Put infected patients in single rooms.
• If multiple patients have the bug, put them in one ward and designate certain people to care for them so the caregivers are not moving between infected and uninfected patients.
• Make sure people don't have catheters inserted any longer than necessary.
• Keep antibiotic use to the absolute minimum.
Hanson, the Creighton professor, said it can be difficult to determine who has the bacteria. She has two grants from private sources to develop a molecular diagnostic tool to detect the genes that cause the bacteria to become antibiotic-resistant.
Meanwhile, Hanson said, people “have a right to know what type of infection they have and whether it has been analyzed appropriately,” she said. “If they're not educated, they can't ask the right questions.”
In most health care settings in the U.S., the bacteria isn't common, the CDC's Kallen said. If people act quickly when the bug is detected, he said, “the hope and expectation is we can at least keep the lid on these until there are better ways to treat them.”