Carbapenem-resistant Enterobacteriaceae

What are CRE?

Carbapenem-resistant Enterobacteriaceae (CRE) are a type of bacteria. They can cause serious infections that can be hard to treat.

CRE got their name from the fact that they are resistant to carbapenems. Carbapenems are an advanced class of antibiotics. They were created in the 1980s to help treat bacteria that could not be treated with other antibiotics.

Antibiotics are used to kill certain types of bacteria. There are many kinds of these medicines. Over time, some bacteria may no longer be killed by them. This is known as antibiotic resistance.

For decades, bacteria have shown resistance to common types of antibiotics. So healthcare providers often turned to carbapenems to kill these germs. But some bacteria have become resistant to these medicines as well.

Before 2000, CRE were fairly uncommon in the U.S. They have become much more common since then. CRE are now a major cause of infections in healthcare settings.

Healthy people usually don't get these infections. People in hospitals have the highest risk of a CRE infection. Those who are very ill are especially at risk. People of all ages can become infected with CRE. Elderly adults and very young children are at the highest risk of dying from CRE infections.

What causes CRE?

High and sometimes excessive use of antibiotics promotes the growth of bacteria like CRE. If you have a bacterial infection, your healthcare provider may treat it with an antibiotic. The medicine will work if you have a nonresistant strain of the bacteria.

But a few bacteria may survive. They may change genetically. These changes can allow them to resist the antibiotic. For example, they may make a substance that disrupts the structure of the antibiotic. These resistant bacteria may then spread. They may cause an infection in you or others.

Who is at risk for CRE infection?

Certain things may make it more likely that you will get a CRE infection. These include:

• A recent stay in the hospital. This is especially true if you were in a hospital where CRE has been found and in an intensive care unit (ICU).

• A stay in a long-term care facility. This is especially true if it's a facility where CRE has been found.

• Exposure to antibiotics

• Recent organ or stem-cell transplantation

• Use of mechanical ventilation

• Use of medical devices inside the body, such as urinary catheters

Other serious illnesses may also raise the risk for death from a CRE infection.

What are the symptoms of CRE infection?

Symptoms of a CRE infection vary. They may differ with the type of the bacteria involved and the part of the body infected.

One example is Klebsiella pneumoniae . It's a type of bacteria that is often resistant to carbapenems. Infection with these bacteria might lead to symptoms, such as:

• Shortness of breath (from pneumonia)

• Pain with urination (from urinary tract infection)

• Pain and swelling of the skin (from skin infection)

• Belly pain (from liver or splenic infection)

• Stiff neck and reduced consciousness (from meningitis infection)

• Fever, chills, and fatigue (from infection in any location)

Infections with other types of CRE may cause different symptoms.

How is CRE infection diagnosed?

Your healthcare provider will first ask you about your health history. They will ask you questions about your symptoms and any past health problems. You will likely also need a physical exam.

Your healthcare provider will likely order some tests. These depend on your symptoms and exam. They might include:

• Complete blood count to look for anemia and infection

• Chest X-ray to check for lung infection

• Urine tests, to look for urinary infection

• Additional imaging tests, if needed

• Blood, urine, sputum, or other body cultures

• Antibiotic sensitivity tests

How is CRE infection treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Your treatment may include the following:

• Careful watching of vital signs, such as heart rate

• Fever-reducing medicines

• IV fluids

• Nutritional support

• Treatment of other health conditions you have

• Breathing machine (ventilator), if needed

• Other antibiotic treatment

In very rare cases, there may not be another antibiotic that works. Supportive care may help you fight the infection.

What are possible complications of CRE infection?

Complications from CRE vary according to the type and site of infection. For example, a lung infection from CRE might result in a lung abscess.

Sepsis is a serious problem caused by CRE. It can lower blood flow to vital organs. It may even cause death.

Can CRE infection be prevented?

Healthcare providers can help prevent the spread of CRE by:

• Carefully watching for CRE infections in healthcare facilities

• Taking care to isolate patients with CRE

• Removing medical devices that are inside the body, such as catheters, as soon as possible

• Only prescribing antibiotics (especially carbapenems) when truly needed

• Using clean (sterile) methods to reduce the spread of infection

• Always practicing standard infection-control methods, such as thorough handwashing

• Reducing time spent in an ICU if you are in the hospital

You can also help prevent the spread of a CRE infection. These are some of the things you can do:

• Always take all of your antibiotics as directed. Do so even when you are feeling better. It will help prevent bacteria, such as CRE.

• Remind your healthcare team to remove possible sources of infection, such as catheters, as soon as possible.

• Always practice correct hygiene. Wash your hands often.

Key points about CRE

• CRE are a group of bacteria that are resistant to certain antibiotics.

• High and sometimes excessive use of antibiotics has played a part in the growth of CRE.

• People in the hospital or with certain medical conditions and treatments are mainly at risk from CRE.

• A CRE infection can affect many parts of the body.

• Your healthcare provider can diagnose a CRE infection with certain tests.

• There may not be an effective antibiotic to treat your CRE infection. Your healthcare team can give you supportive care to help you recover.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.