CDC Guidelines for CRE

CRE, which stands for carbapenem-resistant Enterobacteriaceae, are a family of germs that are difficult to treat because they have high levels of resistance to antibiotics. Klebsiella species and Escherichia coli (E. coli) are examples of Enterobacteriaceae, a normal part of the human gut bacteria, that can become carbapenem-resistant. Types of CRE are sometimes known as KPC (Klebsiella pneumoniae carbapenemase) and NDM (New Delhi Metallo-beta-lactamase). KPC and NDM are enzymes that break down carbapenems and make them ineffective.

Healthy people usually do not get CRE infections. In healthcare settings, CRE infections most commonly occur among patients who are receiving treatment for other conditions. Patients whose care requires devices like ventilators (breathing machines), urinary (bladder) catheters, or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are most at risk for CRE infections.

Some CRE bacteria have become resistant to most available antibiotics. Infections with these germs are very difficult to treat, and can be deadly—one report cites they can contribute to death in up to 50% of patients who become infected.

See also the 2012 CRE Toolkit – Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE)

According to the CDC in Management of Multidrug-Resistant Organisms [MDROs] In Healthcare Settings, 2006:

The potential role of environmental reservoirs, such as surfaces and medical equipment, in the transmission of … MDROs has been the subject of several reports (109-111, 297, 298). While environmental cultures are not routinely recommended (299), environmental cultures were used in several studies to document contamination, and led to interventions that included the use of dedicated noncritical medical equipment(217, 300), assignment of dedicated cleaning personnel to the affected patient care unit(154), and increased cleaning and disinfection of frequently-touched surfaces (e.g., bedrails, charts, bedside commodes, doorknobs). A common reason given for finding environmental contamination with an MDRO was the lack of adherence to facility procedures for cleaning and disinfection. In an educational and observational intervention, which targeted a defined group of housekeeping personnel, there was a persistent decrease in the acquisition of VRE in a medical ICU (301). Therefore, monitoring for adherence to recommended environmental cleaning practices is an important determinant for success in controlling transmission of MDROs and other pathogens in the environment (274, 302).

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