Bad bug, no drugs. What is CRE?

Portrait of Ronald Dworkin, M.D.

Ronald Dworkin, M.D.
Medical director, Providence Infectious Disease Consultants-East

April 17, 2013

By now you’ve read the headlines about the drug-resistant “superbug” – carbapenem-resistant Enterobacteriaceae, or CRE – that is threatening hospitals and long-term care facilities around the country. Although Oregon has a low incidence of these bacteria (fewer than 20 cases have been reported), we can help slow the spread of CRE and prevent them become becoming endemic in Oregon.

CRE are Gram-negative bacilli (mostly Klebsiella and E. coli; see list) that are not only resistant to extended-spectrum cephalosporins, penicillin/beta lactamase inhibitors and quinolones, they also carry a genetic element that confers resistance to the carbapenem antibiotics imipenem, meropenem, ertapenem and doripenem.

CRE first appeared in the United States in 1999, and are now found in at least 42 states. Bloodstream infections due to these organisms carry a 50 percent mortality rate, and spread is occurring rapidly in some parts of the country.

In health care settings, this “human gut bacteria” can cause pneumonia, and surgical site, bloodstream and urinary tract infections, particularly among patients with compromised immune systems. Without proper precautions, these can be transmitted to healthy patients.

The Oregon Health Authority requires reporting of cases of CRE and is developing guidelines to prevent spreading in hospitals and long-term care facilities. Providence’s regional policy on isolation for patients with CRE will be posted on the Providence intranet soon.
Full-barrier isolation should be routine for these patients. Additional measures, such as cohorting and screening of individuals who have been hospitalized in areas with higher incidence of infection with CRE, may be indicated in the future.

Above all, cleaning your hands and good antimicrobial stewardship remain key to controlling incidence and spread of multidrug-resistant organisms.