Patients: Information about CRE

CRE can cause infections in patients in hospitals.

General information about CRE

CRE stands for carbapenem-resistant Enterobacteriaceae. Enterobacteriaceae are a family of germs, specifically bacteria. Many different types of Enterobacteriaceae can develop resistance, including Klebsiella pneumoniae and Escherichia coli (E. coli). These bacteria can cause infections including pneumonia, bloodstream infections, urinary tract infections, wound infections, and meningitis.

CRE are a major concern for patients in healthcare settings because they are resistant to carbapenem antibiotics, which are considered the last line of defense to treat multidrug-resistant bacterial infections. Often, high levels of antibiotic resistance in CRE leave only treatment options that are more toxic and less effective.

How common are CRE infections?

In 2017, CRE caused an estimated 13,100 infections in hospitalized patients, and 1,100 estimated deaths in the United States [Source: 2019 AR Threats Report].

Who is most likely to get a CRE infection?

Healthy people usually do not get CRE infections—they are most common in patients in hospitals and long-term care facilities like skilled nursing facilities and long-term acute care hospitals. Patients whose care requires devices like ventilators (breathing machines), urinary (bladder) catheters, or intravenous (vein) catheters, patients who are taking long courses of certain antibiotics, and patients with weakened immune systems are among those at risk for CRE infections.

What is the difference between colonization and infection?

Some people have germs on or in their body, but those germs do not cause an infection. These people are said to be colonized.

People colonized with CRE can develop infections, but most will not. CRE can cause infections when the germs enter the body, often through medical devices like ventilators, intravenous catheters, urinary catheters, or wounds caused by injury or surgery.

How are CRE germs spread?

CRE are usually spread person to person through contact with infected or colonized people, particularly contact with wounds or stool (poop). This contact can occur via the hands of healthcare workers, or through medical equipment and devices that have not been correctly cleaned.

How can I protect myself from CRE?

As a patient, there are several ways you can protect yourself.

  • Tell your healthcare provider if you have been hospitalized in another healthcare facility, including hospitals in other countries.
  • Make sure all healthcare providers clean their hands before caring for you. If you don’t see your providers clean their hands, ask them to do so.
  • Clean your own hands often, and ask anyone taking care of you to clean their hands:

    Clean Hands Count
    Learn about hand hygiene from CDC’s Clean Hands Count campaign.

    • Before preparing or eating food
    • Before touching your eyes, nose, or mouth
    • Before and after changing wound dressings or bandages
    • Before handling medical devices or touching tubes going into your body
    • After using the bathroom
    • After blowing nose, coughing, or sneezing

Be Informed about Antibiotic Resistance
Information for patients in hospitals and their families

  • If you are prescribed antibiotics, take them exactly as your healthcare provider recommends.
  • Talk to your healthcare provider about your care and any concerns you have. Ask them what they are doing to protect you from getting an infection while receiving care.
  • Avoid preventable infections by making sure you are up to date on all recommended vaccinations.

How are CRE infections treated?

Treatment decisions for patients with CRE infections are made on a case-by-case basis by a healthcare provider. For patients who are colonized with CRE but do not have an infection, treatment is often not required.

What if I have CRE?

Follow your healthcare provider’s instructions. If your provider prescribes antibiotics, take them exactly as instructed and finish the full course, even if you feel better. Clean your hands often, especially after you have contact with the infected area, after using the bathroom, and before preparing or eating food. Follow any other hygiene advice your provider gives you. Be alert to changes in your health (e.g., if you develop diarrhea), and contact your healthcare provider if changes occur.