Deadly Bacterial Los Angeles Nursing Home & Hospital Infections


An outbreak of infections caused by a deadly bacteria thought to be resistant to all current antibiotics and other treatments has been discovered in multiple Los Angeles County medical facilities according to a study set to be released on April 3, 2011, according to a Southern California journalist who obtained the results of the study.

According to the report, Dr. Dawn Terashita, an epidemiologist with the Los Angeles County Department of Public Health, found 356 cases of a drug-resistant form of Klebsiella pneumoniae, also known as CRKP. The majority of discovered cases were found in elderly patients at skilled nursing and long-term long-term care facilities. A small percentage of cases were also discovered at acute care hospitals adding to concern that the deadly organism may be making its way into younger and healthier patient populations.

Doctors at Southern California medical facilities expressed fear of a growing public health threat from the organism which was formerly thought to be confined to the East Coast. There are no antibiotics to treat the infection. It has developed over time to resist the antibiotics currently approved by the U.S. Food and Drug Administration, and some experts say that makes it more threatening than bugs like methicillin-resistant staphylococcus aureus, or MRSA.

“It has killed patients here, for sure,” said Dr. Brad Spellberg, an infectious disease expert and physician at County Harbor-UCLA Medical Center near Torrance. “This is scary stuff. It cannot be treated with any antibiotic that we know of. … We’re at the point with some of this (resistant bacteria) that we’re just mixing a bunch of crap together, throwing it at the patient and crossing our fingers.”

The findings of Terashita’s analysis were to be presented at the Society for Healthcare Epidemiology of America’s conference April 1-4 in Dallas. The society imposed an April 3 “embargo” on the study, but several Southern California news organizations decided to publish the results in advance of formal publication because of the public health concerns involved.

Dr. Terashita said Wednesday that Los Angeles County officials were surprised to find so many cases in long-term care facilities and nursing homes. “We don’t know if the cases are due to lack of proper care, or have to do with the kind of population (these facilities) serve,” she said.

CRKP is resistant to almost all available antimicrobial agents, and infections with CRKP have been associated with high rates of morbidity and mortality, particularly among persons with prolonged hospitalization and those who are critically ill and exposed to invasive devices (e.g., ventilators or central venous catheters). Roughly 2 million people contract bacterial infections in a hospital setting each year, and about 90,000 die, according to the Infectious Disease Society of America. Many of these are elderly patients or those with compromised immune systems, but the young and healthy are susceptible as well, officials say.

According to the Centers for Disease Control and Prevention, many patients are infected with unrecognized CRKP and serve as “reservoirs for transmission” during health-care–associated outbreaks making detection, monitoring and control of the infection difficult. For example, during an outbreak of 39 cases of CRKP infection in a hospital in Puerto Rico in 2008, tests performed on 30 patients in the intensive care unit revealed two infected patients who were not previously known to harbor CRKP and were not placed in isolation which allowed the infections to spread. Control of the outbreak was also hindered by lack of hospital compliance with infection control practices. Health-care personnel adherence to recommendations for gown and glove use was reportedly low at the hospital, as was appropriate hand hygiene practiced by hospital personnel.

While the CDC has published “guidelines” for controlling CRKP, outbreaks may occur as the result of the failure of nursing homes and other facilities to implement appropriate infection control measures on a prophylactic basis.