Healthcare News & Insights

CRE: CDC releases guidelines for leathal, drug-resistant bacteria

The Centers for Disease Control and Prevention (CDC) is calling on all hospitals and long-term care facilities to take extra precautions when it comes to the lethal bacteria Carbapenem-resistant Enterobaceteriaceae (CRE). Reason: CRE is highly resistant to most antibiotics — even the big guns reserved as a last resort when all else fails. 

What has the CDC so nervous is that CRE is on the rise:

  • One type of CRE infection has been reported in medical facilities in 42 states during the last 10 years
  • CRE increased from 1.2% in 2001 to 4.2% in 2011
  • Approximately 4% of hospitals and 18% of long-term care hospitals had at least one patient with a CRE infection during the first half of 2012
  • CRE bloodstream infections are associated with a mortality rates exceeding 40%, and
  • Most CRE are associated with healthcare exposures.

CRE infections are caused by a family of germs that are a normal part of a person’s healthy digestive system. However, these germs can cause infections when they get into the bladder, blood or other areas where germs don’t belong.

The problem is, nearly all CRE infections happen to patients receiving serious medical care. And since enterobacteriaceae are a common cause of community infections, CRE have the potential to move from hospital patients into the community. Also, CRE can spread resistance to other bacteria, such as Escherichia coli.

Prevention is key

The key is to prevent the spread of CRE before it gains a foothold in more hospitals or in the community. Current CRE prevention strategies are based on the identification of patients colonized or infected with CRE followed by implementation of contact precautions.

To help hospitals out, the CDC has published the following prevention guidelines:

  1. Know if patients in your facility have CRE by requesting immediate alerts when the lab identifies CRE
  2. Alert the receiving facility when a patient with CRE transfers, and find out when a patient with CRE transfers into your facility
  3. All healthcare personnel who care for patients with multidrug-resistant organisms need to be educated about preventing transmission of these organisms, including CRE
  4. When treating patients with CRE it’s best to wash hands first before putting on gloves and gowns
  5. Put gloves and gown on before entering an infected patient’s room, and remove them before exiting the room
  6. Dedicate rooms, staff and equipment to patients with CRE
  7. Using medical devices, such as central venous catheters, endotracheal tubes, urinary catheters, etc., can put patients at risk for device associated infection; therefore, minimizing their use is vital
  8. When temporary medical devices are required, remove them from patients as soon as possible, and
  9. Prescribe antibiotics wisely — one-third of antibiotics prescribed to patients in hospitals are unnecessary.

CRE screening

Typically, clinical cultures only identify a fraction of all patients with CRE. If your facility has had unreported cases of CRE, it’s important to do screenings. Reason: They can identify unrecognized CRE colonization among epidemiologically-linked contacts of known CRE colonized or infected patients.

Screenings generally involve stool, rectal or peri-rectal cultures and sometimes cultures of wounds or urine. CRE screenings of epidemiologically linked patients are a primary prevention strategy for all healthcare facilities.

Point prevalence surveys are also an effective way for facilities to evaluate the prevalence of CRE in particular areas of a hospital. They’re generally conducted by screening all patients in a specific area. They can be done once if a few CRE patients are identified or periodically if the infection is more wide spread.

Additional measures

For facilities that are having a difficult time reducing their incidence of CRE infections, there are additional measures they can take. They include:

  • Active surveillance Testing — This requires culturing patients who meet certain pre-specified criteria, such as being admitted from a long-term care facility or to a high-risk setting, such as the intensive care unit, but who may not be linked to CRE patients. Typically active surveillance testing is done at admission.
  • Chlorhexidine bathing — This tactic has been used to reduce the prevalence of CRE during an outbreak. According to the CDC, diluted liquid chlorhexidine (2%) or 2% chlorhexidine-impregnated wipes are used to bathe patients (usually daily) while in high-risk settings. The chlorhexidine isn’t used above the jaw line or on open wounds. When chlorhexidine bathing is used for a particular patient population or in a particular setting, it is usually applied to all patients regardless of CRE colonization status.

For a copy of Guidance for Control of Carbapenem-resistant Enterobacteriaceae, click here.



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