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CRE (Carbapenem Resistant Enterobacteriaceae)

Medically reviewed by Last updated on Oct 3, 2022.

What are carbapenem-resistant Enterobacteriaceae (CRE)?

CRE are a group of bacteria that are very difficult to kill when they cause infection. Examples include E. coli and klebsiella. CRE often cause lung, urinary tract, wound, and blood infections. Carbapenems are a group of antibiotics that treat bacterial infections. In CRE infections, the bacteria release chemicals that prevent carbapenems from killing them. This is called antibiotic resistance. CRE infections can become difficult to cure and can spread to other parts of the body. CRE infections that get into the blood can be life-threatening.

What is the difference between CRE colonization and CRE infection?

CRE colonization means that CRE can be found in the body, but are not causing infection. CRE infection happens when CRE travel to parts of the body that do not normally have bacteria there. These areas include the bladder, lungs, and blood.

Who is at risk for CRE infection?

Healthy people usually do not get an infection after exposure to CRE. You may be at higher risk for CRE infection if you have any of the following:

  • A weak immune system
  • Being treated for an illness in an acute or long-term hospital
  • Recent treatment with certain antibiotics
  • Recent medical treatment in another country with a high risk of CRE infection
  • A recent procedure such as an endoscopic retrograde cholangiopancreatography (ERCP)

How are CRE spread?

CRE can spread from person to person through contact with an infected person's wound, bowel movements, urine, or sputum. CRE can be spread if a person touches an object that has CRE and touches another person. Stethoscopes, blood pressure cuffs, and thermometers can spread CRE from one patient to another if they are not cleaned correctly. CRE can get into the body through medical devices such as a ventilator (breathing machine), urinary catheter, or IV catheter. Poor handwashing is a major reason for the spread of CRE.

What are the signs and symptoms of CRE infection?

The signs and symptoms of CRE infection depend on which body part is infected. You may have any of the following:

  • Fever and chills
  • Little or no energy
  • Loss of appetite
  • Nausea and vomiting
  • Cough or difficulty breathing
  • Painful or difficult urination
  • A rash or red, swollen skin with pus

How are CRE colonization and infection diagnosed?

You may need separate tests to check for colonization and infection:

  • CRE colonization can be diagnosed through a rectal or perirectal swab. Your healthcare provider will take a sample from the area outside of your rectum, or inside your rectum. A sample of your bowel movement may also be tested for CRE.
  • CRE infection can be diagnosed through blood and urine tests, or from abscess or infected tissue cultures. Fluid may be drained from an abdominal abscess and sent to the lab to be tested for CRE infection. If CRE infection is found, it will be tested in the lab for its reaction to antibiotic medicine. This will help your healthcare provider decide what antibiotics will kill the bacteria in your body.

How is CRE treated?

You will not need treatment if you have CRE in your body but are not infected. If CRE is causing an infection, you may need any of the following:

  • Antibiotics are used to treat the infection. Several kinds of antibiotics may need to be tried. You may be given 2 or more antibiotics at the same time. Your healthcare provider may ask if you received antibiotics within the past month. This will help him or her choose different antibiotics to lower the risk for resistance.
  • Surgery or other procedures may be needed to drain an abscess (collection of fluid) or remove infected tissue.

How do healthcare providers prevent the spread of CRE?

  • Wash their hands with soap and water or an alcohol-based sanitizer before and after they care for a patient.
  • Clean and disinfect rooms and medical equipment.
  • Use contact precautions for any patient with a CRE infection. This means healthcare providers will wear a gown and gloves before they enter a patient's room. It also means they will keep patients with CRE infection in a single room or the same room as another patient with CRE infection. Healthcare providers can only use certain equipment with patients that have a CRE infection. They will remove gowns and gloves before they leave a patient's room.
  • The same healthcare providers will care for patients with CRE on a unit or area of the hospital. This may prevent the spread of CRE from patients with CRE to patients that do not have CRE.
  • Limit antibiotic prescriptions so they are only given when necessary. Some antibiotics may kill good bacteria and increase your risk for CRE. Healthcare providers will use antibiotics only when necessary, and for the shortest amount of time possible.
  • Remove all drains and catheters as soon as possible. This may prevent CRE from getting into areas of the body that are at risk for infection.
  • Test all patients at risk for CRE. This may help healthcare providers identify patients with CRE and prevent bacteria from being spread to other patients.

How can I help prevent the spread of CRE?

  • Tell your healthcare provider if you have been hospitalized in another hospital or country. This may tell your healthcare provider if you are at risk for CRE and help you get early treatment for infections.
  • Take antibiotics as directed. Do not take antibiotics when you do not need them. Do not share antibiotics or take other people's antibiotic medicine. Overuse of antibiotics can kill the good bacteria in your gut, and increase your risk for CRE. You could also spread CRE to others.
  • Wash your hands often. Wash your hands several times each day. Wash after you use the bathroom, change a child's diaper, and before you prepare or eat food. Use soap and water every time. Rub your soapy hands together, lacing your fingers. Wash the front and back of your hands, and in between your fingers. Use the fingers of one hand to scrub under the fingernails of the other hand. Wash for at least 20 seconds. Rinse with warm, running water for several seconds. Then dry your hands with a clean towel or paper towel. Use hand sanitizer that contains alcohol if soap and water are not available. Do not touch your eyes, nose, or mouth without washing your hands first.

When should I call my doctor?

  • You have a fever or chills.
  • You have a wound that is red, swollen, or draining pus.
  • You have had contact with someone with a CRE infection.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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