Carbapenem-resistant Enterobacteriaceae (CRE) Infection
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.
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.
- Design of Endoscopic Retrograde Cholangiopancreatography (ERCP) Duodenoscopes May Impede Effective Cleaning
- CDC Statement: Los Angeles County/UCLA Investigation of CRE Transmission and Duodenoscopes
- New Delhi Metallo-β-Lactamase–Producing Carbapenem-Resistant Escherichia coli Associated With Exposure to Duodenoscopes
- Notes from the Field: New Delhi Metallo-β-Lactamase–Producing Escherichia coli Associated with Endoscopic Retrograde Cholangiopancreatography — Illinois, 2013
- Notes from the Field: Hospital Outbreak of Carbapenem-Resistant Klebsiella pneumoniae Producing New Delhi Metallo-Beta-Lactamase — Denver, Colorado, 2012. MMWR February 15, 2013 / 62(06);108-108
- Carbapenem-Resistant Enterobacteriaceae Containing New Delhi Metallo-Beta-Lactamase in Two Patients — Rhode Island, March 2012. MMWR June 22, 2012 / 61(24);446-448
- Carbapenem-Resistant Klebsiella pneumoniae Associated with a Long-Term--Care Facility --- West Virginia, 2009—2011. MMWR October 21, 2011 / 60(41);1418-1420
- Notes from the Field: Detection of blaNDM-1 Carbapenem Resistance in a Clinical Isolate of Providencia stuartii in a U.S./Coalition Medical Facility --- Afghanistan, 2011. MMWR June 10, 2011 / 60(22);756
- Update: Detection of a Verona Integron-Encoded Metallo-Beta-Lactamase in Klebsiella pneumoniae — United States, 2010. MMWR September 24, 2010 / 59(37);1212
- Detection of Enterobacteriaceae Isolates Carrying Metallo-Beta-Lactamase — United States, 2010. MMWR June 25, 2010 / 59(24);7503
- 2012: CRE Toolkit Guidance for Control of Carbapenem-resistant Enterobacteriaceae
- Laboratory protocol: Multiplex Real-Time PCR Detection of Klebsiella pneumoniae carbapenemase and New Delhi metallo-β-Lactamse genes [PDF - 110 KB]
- CRE Definition
- Medscape Slideshow: Antibiotics for Carbapenem-Resistant Enterobacteriaceae: The End Is Near
- CDC Health Advisory: New Carbapenem-Resistant Enterobacteriaceae Warrant Additional Action by Healthcare Providers
- Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities. MMWR March 20, 2009 / 58(10);256-260
- Get Smart for Healthcare: Implementing and Improving Antibiotic Stewardship Efforts
- Carbapenem-Resistant Enterobacteriaceae: Epidemiology and Prevention: CID July 2011 [PDF - 275 KB]