Carbapenem-resistant Enterobacterales

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Carbapenem-resistant Enterobacterales

Carbapenem-resistant Enterobacterales (CRE) are a family of germs that are difficult to treat because they also have high levels of resistance to a class of antibiotics called carbapenems. Also, they can develop carbapenemase-producing genes that make the organism more dangerous by transmitting these genes to other organisms. They represent a serious threat to public health. Klebsiella species and Escherichia coli (E. coli) are examples of Enterobacterales, a normal part of the human gut bacteria, that can become resistant to antibiotics. Healthy people usually do not get CRE infections since 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 take long courses of certain antibiotics are most at risk for CRE infections.

CRE infections are difficult to treat and have been associated with mortality rates of up to 50% for hospitalized patients.

Healthcare providers should:

Recognize these organisms as important to patient safety and adhere to public health guidance for CRE detection, tracking, and reporting.
Ensure proper precautions are implemented for CRE colonized or infected patients.
Healthcare personnel should follow standard hand hygiene practices, which include use of alcohol-based hand sanitizer or, if hands are visibly soiled, washing with soap and water.
When a patient with an unusual type of carbapenemase-producing CRE is identified in your facility, work with public health to prevent spread, including following guidance to assess for ongoing transmission.
Have a system to assess, at admission, if a patient has received medical care somewhere else, including other facilities or other countries.
Screen patients who have had an overnight stay in a healthcare facility outside the United States in the prior 6 months for the presence of carbapenemase-producing CRE.
When you transfer a patient or resident, require staff to notify the receiving facility about infection or colonization with CRE and other multidrug-resistant organisms.
Support healthcare providers and prescribe and use antibiotics appropriately.
Participate in regional and facility-based prevention efforts designed to stop the transmission of these organisms.

A majority of these recommendations are directly from the CDC.

CDC clinician information about CRE