News & Updates

January 20, 2020

CRE: an overview

The dangers of Carbapenem-resistant Enterobacteriaceae

When it comes to Carbapenem-resistant Enterobacteriaceae, think of Ebola. The threat of CRE infection can be as deadly as the Ebola Virus, with an estimated hospital mortality rate of 29%–52%. Enterobacteriaceae refer to a family of bacteria naturally found in the gut. CRE is predominately spread in hospitals and long-term care through medical devices and the hands of healthcare workers. Enterobacteriaceae bacteria harbour encoding genes, allowing CRE to easily spread from person to person. While people can be colonised with CRE, it is predominately associated with pneumonia and bloodstream and urinary tract infections. The highest risk cohort are severely ill patients with comorbidities and indwelling devices, such as ventilation and catheterisation.

The study

The American Journal of Infection Control recently published a retrospective study of Carbapenem-resistant Enterobacteriaceae patient outcomes in a long-term hospital environment. The findings, as with previous comparative studies, were sub-optimal. CRE is poorly understood, making treatment difficult, if not impossible. The gram-negative bacteria has a protective enzyme that renders most antibiotic treatment ineffective. This resistance makes it a substantial outbreak threat, both within healthcare facilities and externally.

While there is no standardised clinical guideline for CRE treatment, the study looked towards empiric antibiotic management for suspected CRE infection. A subsequent data analysis informed an algorithm that intended to highlight a regimen aimed at better patient outcomes.

The results showed an overall mortality rate of 17% within 28 days, but up to 25% in patients with bacteraemia. The study notes that these figures, while still largely unacceptable, are a noted improvement to previous studies.

The study acknowledges that there are very few up-and-coming antimicrobial treatments, and that as quickly as treatments emerge, resistance develops. Unfortunately, Carbapenems are last resort antibiotics.

Hand hygiene remains a primary area of focus in the management of CRE. The study, along with the World Health Organisation, maintain that IPC is the cornerstone of controlling the development and spread of CRE and other resistant bacteria. CRE management guidelines rely heavily on facility commitment and adherence to IPC programs.

If you need more information about managing CRE or any other infection prevention and control issues in your facility, why not contact us for a free 20-minute IPC consultation?