CRE: The ‘nightmare bacteria’

We expect antibiotics to work for every infection, but they don’t… anymore

CRE (carbapenem-resistant Enterobacteriaceae) infections come from bacteria that are normally found in a healthy person’s digestive tract. When a person is receiving serious medical care (for example, involving urinary catheters, intravenous catheters, or surgery) these bacteria can end up where they don’t belong—for example in the bladder or blood. Because these bacteria have become resistant to antibiotics, these infections are very difficult to treat.

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Did you know?

  • Antibiotic resistance is one of the world’s most pressing public health threats.
  • The bacteria known as CRE kill up to half of patients who get bloodstream infections.
  • In 2012 the Centers for Disease Control and Prevention (CDC) documented that people in 42 states had been infected with CRE bacteria.
  • Even the antibiotics known as ‘the last resort’ medications no longer work and have made some infections impossible to cure.
  • Antibiotic overuse increases the development of drug-resistant bacteria.

Who is at risk for CRE?

CRE infections are more commonly seen in ill patients who are in and out of hospitals and those patients with exposure not only to acute care, but also long-term care settings as well.

Spread of CRE infection

  • To get a CRE infection, a person must be exposed to CRE bacteria.
  • CRE bacteria are most often spread person-to-person in healthcare settings specifically through contact with:
    • infected or colonized people
    • contact with wounds or stool 
  • CRE can cause infections when they enter the body, often through medical devices such as: 
    • intravenous catheters
    • urinary catheters
    • through wounds caused by injury or surgery

Why we MUST act now

  • CRE bacteria are able to give their antibiotic resistance to any neighboring bacteria—essentially they can easily spread resistance, making many more bacterial types potentially untreatable as well.
  • Antibiotic resistance is not only a problem for the person with the infection, but for all of us because it directly impacts how effective the treatment will be tomorrow or in another patient.
  • Antibiotics are a shared resource!!
  • Some CRE bacteria have become resistant to ALL or almost all antibiotics, including last-resort drugs called carbapenems.
  • CRE bacteria are spreading, and urgent action is needed to stop them.

According to the CDC, the U.S. is at a critical time in which CRE infections could be controlled—that’s the good news. However, there must be a rapid and consistent effort by doctors, nurses, lab staff, medical facility leadership, health departments/states, policy makers, and the federal government, and YOU the public. 

What you can do now

  1. Tell your doctor if you have been hospitalized in another facility or country.
  2. Take antibiotics exactly as the doctor prescribes. Do not skip doses, and complete the entire prescription, even if you start feeling better.
  3. Only take antibiotics prescribed for you; do not share or use leftover antibiotics.
  4. Do not save antibiotics for the next illness. Discard any leftover medication once the prescribed course of treatment is completed.
  5. Prevent infections by covering your cough, getting recommended vaccinations, and regularly washing your hands!  Clean your own hands often, especially: 
    • Before preparing or eating food
    • Before touching your eyes, nose, or mouth
    • Before and after changing wound dressings or bandages, or handling medical devices
    • After using the bathroom
    • After blowing your nose, coughing, or sneezing
  6. Do not ask your doctor for antibiotics if your doctor feels you don’t need them.
  7. Ask questions. Understand what is being done to you, the risks and benefits.
  8. When you are in a healthcare facility, insist that everyone who takes care of you clean their hands with soap and water or an alcohol-based hand rub before touching you! And remind them to wash their hands again as they leave your room!

Additional resources
CDC Vital Signs, March 2013—Stop infections from lethal CRE germs now
APIC—Antibiotics: preserving them for the future
CDC—Get Smart: Know when antibiotics work
CDC—Get Smart: Antibiotics quiz