By Dan Hounsell

As the COVID-19 pandemic moves through its third year, hospitals and other healthcare facilities continue their battle against equally stubborn challenges — superbugs and healthcare-acquired infections (HAI). Now evidence has emerge that the challenge of preventing such infections might be moving beyond the walls of facilities, complicating efforts to control them. 

Researchers with the Centers for Disease Control and Prevention (CDC) and eight U.S. public health departments recently reported that 1 in 10 infections caused by carbapenem-resistant Enterobacterales (CRE) were community-associated, occurring in patients without the known healthcare risks, like hospitalization or stays in long-term care facilities, that are typically associated with CRE infections, according to the Center for Infectious Disease Research and Policy. 

Most were found in white women with urinary tract infections (UTIs). Furthermore, molecular analysis of samples from those infections identified the presence of an enzyme that makes bacteria resistant to multiple classes of antibiotics and is carried on mobile genetic elements that are easily shared with other bacteria. 

The findings are concerning because CRE infections are resistant to most antibiotics and are considered a major public health threat by the CDC. And while CRE are already a major target of hospital infection prevention and control efforts, the worry is that once they are established in the community and in a broader population, it will likely be more difficult to control them. 

"CRE cause difficult-to-treat infections and have the potential to spread rapidly, including outside of the healthcare setting, where most cases currently occur … and some Enterobacterales are common causes of infection that occur in the community already," says Sandra Bulens, CDC epidemiologist and lead study author. "So there's a real potential for these organisms to spread into the community." 

Dan Hounsell is senior editor of the facilities market. He has more than 25 years of experience writing about facilities maintenance, engineering and management.