About Carbapenem-resistant Enterobacterales (CRE)

Overview

Enterobacterales are a group of bacteria (germs) that are a normal part of the human and animal gut but can also cause infections. Carbapenem-resistant Enterobacterales (CRE) are germs resistant to one or several antibiotics called carbapenems.

In the United States in 2020, there were approximately 12,700 infections and more than 1,100 deaths due to CRE.1 The annual incidence of CRE rose 18% from 2019 to 2023.2

Types

CRE can include germs like Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) if they develop resistance to carbapenems.

New Delhi metallo-β-lactamase producing carbapenem-resistant Enterobacterales (NDM-CRE) are a type of CRE bacteria that cause infections, which are extremely hard to treat. NDM-CRE are spreading rapidly in the United States with an increase of 461% between 2019 and 2023.2

Signs and symptoms

• Pneumonia
• Bloodstream infections
• Urinary tract infections
• Wound infections
• Meningitis

Who is at risk

Patients in healthcare settings are at most risk for CRE, especially those who:

• Require devices like ventilators (breathing machines), urinary (bladder) catheters, or intravenous (vein) catheters.
• Are taking long courses of certain antibiotics.
• Have weakened immune systems.

Healthy people usually do not get CRE infections.

How it spreads

• Person-to-person contact from dirty hands, wounds, or stool (poop).
• Contaminated medical equipment and devices.

A few reports described spread between animals and humans and animal-to-animal spread.

In some cases, people or animals can carry the germs on or in their body without being infected, known as colonization.

Reducing risk

• Take antibiotics exactly as your healthcare provider recommends.
• Follow patient safety tips in healthcare settings.
• Keep your hands clean.

Treatment and recovery

CRE infections are difficult to treat. They are resistant to most antibiotics, including carbapenems, drugs often used to treat multidrug-resistant bacterial infections. Healthcare providers make treatment decisions for CRE infections on a case-by-case basis. If your provider prescribes antibiotics, take them exactly as instructed and finish the full course, even if you feel better.

Colonized patients often do not require treatment.

Animal impact

• Animals can get CRE from many sources, including colonized people or animals. The risk of pet owners getting CRE from their pet is low.
• Scientists are still working to understand how long animals carry CRE, but they may carry it longer if they are exposed or if they receive antibiotics.3
• Talk to your veterinarian about CRE and if your pet has a history of CRE.

What CDC is doing

• Providing testing to identify antimicrobial resistance cases, measure resistance and track transmission in a healthcare setting through the Antimicrobial Resistance Laboratory Network.
• Tracking CRE infections through the Emerging Infections Program and National Healthcare Safety Network.
  • Data is also available on the AR & Patient Safety Portal.
• Working closely with health departments, other federal agencies, healthcare providers and patients to prevent infections caused by CRE and slow the spread of resistant germs.

Resources

• Reference Antimicrobial Susceptibility Testing (AST) Data