More commonly known as CRE, carbapenem-resistant Enterobacteriaceae are bacteria that are located in a person’s gastrointestinal (GI) tract that can cause major infections. Some of these Enterobacteriaceae are resistant to antibiotics, making it harder to eradicate CRE from hospital settings. While they were common in the US before 1992, they have recently become a much bigger problem. Enterobacteriaceae that produce a certain arbapenemase have become a major issue.
CRE can become resistant to carbapenems for a number of reasons. In the past, most CRE were resistant to carbapenems for a number of reasons but recently things have changed. As Klebsiella pneumoniae carbapenemase (KPC) and other carbapenamases have emerged, they have caused CRE to become more resistant. Genes on KPC are very mobile and can be transmitted easily from one bacterium to others very quickly, which causes resistance to spread. This means that more and more bacteria are becoming resistant to the usual treatment types, leaving doctors and other medical care professionals wondering how they will treat these medical problems.
Unfortunately, these Enterobacteriaceae are becoming more and more common in the US. While there isn’t systematic surveillance from the CDC, passive surveillance shows an increase in numbers. This is especially true for people who have been exposed to the bacterium in other countries where it is endemic.
CRE are very important and need to be studied and understood for many reasons. Primarily, these are organisms that are resistant to many types of antibiotics, leaving people wondering how to remove CRE (Carbapenem-resistant Enterobacteriaceae) in health care settings. Additionally, these organisms have very high mortality rates with some studies showing rates of up to 50%. Third, there are many CRE that have carbapenemases that can transmit from one bacterium to another, causing resistance to spread. Finally, infections in healthcare and community settings are often caused by Enterobacteriaceae. If they become resistant to treatment, then this is going to be a major problem as people try to figure out how to kill CRE bacteria.
CRE can either be classified as a colonization or an infection. If there is a colonization, then there is CRE on the body but there is no disease or symptom. They can later cause infections if they are able to enter areas in the body such as the lungs, bladder, or bloodstream. Infections have symptoms that can vary depending on what part of the body was affected.
Anyone who works in healthcare, is in a medical setting for treatment, or is exposed to antimicrobials is at risk for acquisition. Outbreaks are often associated with long-term care, mechanical ventilation, and antimicrobials such as fluoroquinolones and carbapenems.
Medical experts want to prevent the transmission of CRE by identifying cases, placing infected patients in isolated areas, and using antimicrobials carefully.
Infections can occur in almost any part of the body including intra-abdominal abscesses, bloodstream infections, and pneumonia. Most CRE bacterial infections target the urinary tract, specifically in those who have catheters or urinary retention. CRE can kill up to 50% of all people who have bloodstream infections.
Transmission CRE is generally transmitted from one person to another via contaminated equipment or hands. Good hand hygiene and personal protective equipment are both imperative to stop the spread of CRE. When to Stop Isolation The CDC has not made a recommendation on when to stop isolating patients due to CRE. People can actually be colonized by CRE for months at a time, which means that they can still be considered dangerous. Doctors who want to eliminate CRE from nursing homes shouldn’t discontinue isolation based on one negative culture because past studies have shown that CRE may still be present on the patient. Rapidly isolating patients who are colonized or infected is important but so is treating the environment. Using hydroxyl generator air machines from Odorox is a great way to find and eradicate CRE in the environment. They can kill CRE in the air and on surfaces, producing a cleaner and safer hospital, nursing home, or other healthcare area.
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