Call to action issued on CRE

The Centers for Disease Control and Prevention (CDC) is on the offensive against hard-to-treat – and sometimes untreatable – infections from carbapenem-resistant Enterobacteriaceae (CRE). Although healthy people do not get CRE infections, according to the CDC, patients in settings whose care requires devices such as ventilators, urinary or intravenous catheters, as well as patients taking long courses of certain antibiotics, are susceptible.

CDC categorizes CRE as "an important threat to public health." CRE typically occurs in ill patients and patients with exposure to acute and long-term care settings. CRE bacteria are most often spread person-to-person in healthcare settings through contact with infected or colonized people, particularly contact with wounds or stool, according to the CDC. CRE can cause infections when they enter the body – often through devices – or through wounds caused by injury or surgery, the agency explained.

The bacteria kill up to half of patients who get bloodstream infections from them, CDC reported in a March 5 news release. During the first half of 2012, almost 200 hospitals and long-term acute care facilities treated at least one patient with CRE, the agency said.

“CRE are nightmare bacteria. Our strongest antibiotics don’t work and patients are left with potentially untreatable infections,” said CDC Director Tom Frieden, MD, MPH, in the news release. “Doctors, hospital leaders and public health must work together now to implement CDC’s 'detect and protect' strategy and stop these infections from spreading.”

Later on March 5, during a CDC telebriefing on CRE, Frieden told reporters: "It's not often that our scientists come to me to say that we have a very serious problem, and we need to sound an alarm. But that's exactly what we're doing today…We need healthcare leaders, clinicians, health departments, to act to prevent CRE so it doesn't become widespread and spread to the community."

Frieden explained that CRE is not nearly as widespread as Methicillin-resistant Staphylococcus aureus (MRSA). "It's important that we keep it that way because [CRE] is so dangerous in terms of both the high fatality rate among patients who have it, the limited treatment options and its ease of spreading among patients and among bacteria."

Frieden added that the good news about CRE is that a coordinated effort can prevent its further spread. "[P]laces that have implemented our recommendations have been able to drastically reduce their number of cases. We know it's serious problem," he continued, "but we also know it's a problem that we can stop."

Six states currently mandate reporting for CRE: Colorado, Minnesota, North Dakota, Oregon, Tennessee and Wisconsin. Other states are considering mandatory reporting, according to Frieden.

CRE-prevention recommendations for hospitals, long-term acute care facilities, nursing homes and health departments include the following:

  • enforcing use of infection control precautions (standard and contact precautions);
  • grouping together patients with CRE;
  • dedicating staff, rooms and equipment to the care of patients with CRE, whenever possible;
  • having facilities alert each other when patients with CRE transfer back and forth;
  • asking patients whether they have recently received care somewhere else (including another country); and
  • using antibiotics wisely.

In addition, because of the way CRE can be carried by patients from one healthcare setting to another, facilities are encouraged to work together regionally to implement CRE prevention programs, the CDC said.

Click here for clinician-relevant resources on CRE.

Photo courtesy of CDC.