Over the past few weeks at Ronald Reagan UCLA Medical Center in Los Angeles, California, 179 patients were exposed to Carbapenem-resistant enterobacteriaceae or CRE, resulting in seven patients being infected and two deaths. This is a lethal bacterium that is very resistant to antibiotics and has resulted in significant discussion in the press. Hospital patients with compromised immune systems are susceptible to infections passed on from other patients and hospital equipment and in the current case of CRE at UCLA, a contaminated endoscope.
Another prominent cause of infection is the bacteria enterococci, specifically vancomycin-resistant enterococci (VRE), which, as the name states, are resistant to the antibiotic vancomycin. In healthy individuals, the bacteria are not a threat and are usually killed by the immune system. In cancer patients, the elderly, transplant recipients, and other patients on antibiotics, the weakened immune system and microbiome colonization cannot fight the colonization of VRE in the gut. The result is an infection of the intestines, and possibly of the urinary tract, blood stream, and heart.
In an article published in FEMS Microbiology Letters in early February, the authors summarize research that is being done to overcome the issue of VRE infection. Infection by enterococci often occurs in patients who have taken antibiotics that deplete beneficial bacteria in the gut. One possible fix for this problem could be the administration of probiotics, live microorganisms that provide a health benefit. Unfortunately, limited research has been done in this area. In one inconclusive study, Lactobacillus rhamnosus appeared to eliminate or at least decrease the presence of VRE in the gut. Other studies suggest that it is easier to prevent infection of, rather than eradicate already present VRE.
Another area of investigation is the use of commensal bacteria to prevent infection, or the administration of normal gut-colonizing bacteria. A popular topic in microbiome research, and one that often, and recently, appears on our blog is the treatment of infection of Clostridium difficile. One method of treatment that we frequently discuss is fecal microbiota transplant (FMT). The authors of this article suggest the use of FMTs may be able to be applied for the treatment of enterococci infection.
Many hospital patients get sick from infections passed within the hospital, as their compromised immune systems cannot stave off infection. Hospitals are supposed be a place for getting healthier, yet we know that hospital-acquired infections are a major issue in today’s hospital systems as we have seen over the past few weeks at UCLA. New strategies for overcoming these issues are being pursued and are very important for the prevention of deaths resulting in bacterial infections passed within hospitals.