Carbapenem-resistant Enterobacteriaceae

What are CRE?

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

CRE got their name from the fact that they are resistant to carbapenems. Carbapenems are a class of antibiotics. They were created in the 1980s.

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 do not get these infections. Patients 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. The elderly and the very young are mainly at risk of dying from CRE infections.

What causes CRE?

An overuse 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.

What are the risks for CRE infection?

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

• A recent stay in the hospital (especially one where CRE has been found)
• A stay in a long-term care facility (especially one 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 (like urinary catheters)

Other factors may raise the risk of death from a CRE infection. These include other serious illnesses.

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 is a type of bacteria that is often resistant to carbapenems. Infection with these bacteria might lead to symptoms like:

• 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 take a medical history. He or she will ask you questions about your symptoms and any past medical problems. You will likely also need a medical 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, if needed
• Blood culture and sensitivity tests

A blood culture test shows what type of bacteria is making you sick. The sensitivity test can tell your healthcare provider which medicine will kill the bacteria.

How is CRE infection treated?

Your healthcare provider will figure out the best treatment for you based on:

• How old you are
• Your overall health and medical history
• How sick you are
• How well you can handle specific medicines, procedures, or therapies
• How long the condition is expected to last
• Your opinion or preference

Your treatment may include the following:

• Careful monitoring of vital signs, such as heart rate
• Fever-reducing medicines
• IV fluids
• Nutritional support
• Treatment of co-existing medical conditions
• Ventilator support, if necessary
• Alternative antibiotic treatment

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

What are the 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 professionals can help prevent the spread of CRE by:

• Carefully monitoring for CRE infections in healthcare facilities
• Taking precautions 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 necessary
• Using sterile techniques to minimize the spread of infection
• Always practicing standard infection-control techniques (like thorough hand-washing)

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 like CRE.
• Remind your healthcare team to remove possible sources of infection (like catheters) as soon as possible.
• Always practice proper hygiene. Wash your hands often.

Key points about CRE

The CRE are a group of bacteria. They are resistant to antibiotics called carbapenems. Infections with CRE are often hard to treat. These infections often lead to death. That’s especially the case in people who are already very ill.

• Improper use of antibiotics has played a part in the growth of CRE.
• The elderly and people with severe medical problems 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 medical 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.