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Carbapenem-resistant Enterobacteriaceae (CRE) information for providers

Learn about CRE and steps to take when treating CRE infections.

CRE, which stands for carbapenem-resistant Enterobacteriaceae, are a family of germs that are difficult to treat because they are highly resistant to antibiotics. Klebsiella species and Escherichia coli (E. coli) are examples of Enterobacteriaceae, a normal part of the human gut bacteria that can become carbapenem-resistant. The reason why CREs are resistant to carbapenems is because they produce carbapenemases such as KPC (Klebsiella pneumoniae carbapenemase), NDM (New Delhi Metallo-beta-lactamase), OXA-48 like (Oxacillinase) and IMP (Imipenemase Metallo-beta-lactamase). These are all enzymes that break down carbapenems and make them ineffective. KPC and NDM, as well as the enzyme VIM (Verona Integron-Mediated Metallo-β-lactamase) have also been reported in Pseudomonas.

Healthy people usually do not get CRE infections – they usually happen to patients in hospitals, nursing homes, and other healthcare settings. Patients whose care requires devices like ventilators (breathing machines), urinary (bladder) catheters, or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are most at risk for CRE infections.

Some CRE bacteria have become resistant to most available antibiotics. Infections with these germs are very difficult to treat, and can be deadly—one report cites they can contribute to death in up to 50% of patients who become infected.

Clinicians play a critical role in slowing the spread of CRE. Rapidly identifying patients colonized or infected with these organisms and placing them in Contact Precautions when appropriate, using antibiotics wisely, and minimizing device use are all important parts of preventing CRE transmission.

Steps clinicians should take

  • Know if patients with CRE are hospitalized at your facility, and stay aware of CRE infection rates. Ask if a patient has received medical care somewhere else, including another country.
  • Place patients currently or previously colonized or infected with CRE on Contact Precautions. Whenever possible, dedicate rooms, equipment, and staff to CRE patients.
  • Wear a gown and gloves when caring for patients with CRE
  • Perform hand hygiene – use alcohol-based hand rub or wash hand with soap and water before and after contact with patient or their environment
  • Alert the receiving facility when you transfer a CRE patient, and find out when a patient with CRE transfers into your facility
  • Make sure labs immediately alert clinical and infection prevention staff when CRE are identified
  • Prescribe and use antibiotics wisely
  • Discontinue devices like urinary catheters as soon as no longer necessary

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