Carbapenem-resistant enterobacteriaceae

What is Carbapenem-resistant enterobacteriaceae?

Carbapenem-resistant Enterobacteriaceae (CRE) are a type of bacteria. They can cause serious infections that can be hard to treat. CRE got their name from the fact that they are resistant to carbapenems. Carbapenems are an advanced class of antibiotics.

What is the epidemiology of CRE?

The prevalence of CRE, according to some institutions in epidemic area, varies between 24.7% and 29.8%. The rapid and extensive dissemination of CRE demonstrated that we still lacked sufficient and effective measures to reverse or at least control the current situation.

What causes CRE?

CRE are usually spread person to person through contact with infected or colonized people, particularly contact with wounds or stool (poop). This contact can occur via the hands of healthcare workers, or through medical equipment and devices that have not been correctly cleaned.

How to prevent CRE?

The most important way to prevent the spread of CRE and other antibiotic-resistant infections is to practice good hand-washing. Wash your hands often using soap and water or use an alcohol-based hand sanitizer. Check that anyone who is providing your care also washes his or her hands often.

 

Hand washing is the way!!

NB!!

1. CRE are a group of bacteria that are resistant to certain antibiotics.
2. High and sometimes excessive use of antibiotics has played a part in the growth of CRE.
3. People in the hospital or with certain medical conditions and treatments are mainly at risk from CRE.
4. A CRE infection can affect many parts of the body.
5. Your healthcare provider can diagnose a CRE infection with certain tests.
6. There may not be an effective antibiotic to treat your CRE infection. Your healthcare team can give you supportive care to help you recover.

Symptoms

Symptoms of a CRE infection vary. They may differ with the type of the bacteria involved and the part of the body infected.

One example is Klebsiella pneumoniae . It's a type of bacteria that is often resistant to carbapenems. Infection with these bacteria might lead to symptoms such as:

• Shortness of breath (from pneumonia)
• Pain with urination (from urinary tract infection)
• Pain and swelling of the skin (from skin infection)
• Belly pain (from liver or splenic infection)
• Stiff neck and reduced consciousness (from meningitis infection)
• Fever, chills, and fatigue (from infection in any location)

Infections with other types of CRE may cause different symptoms.

Risk factors of CRE

The main risk factors for CRE acquisition in the United States include exposure to healthcare and exposure to antibiotics. Healthcare-related risk factors include requiring help with most activities of daily living, like toileting and bathing, exposure to an intensive care unit, and mechanical ventilation.

Why are isolation precautions?

Isolation precautions are steps we take to stop infections from spreading from person to person. If you're diagnosed with or exposed to a CRE infection while you're in the hospital: You will be placed in a private room.

The contact precautions are currently recommended to prevent nosocomial transmission of CRE for patients with known or suspected infections or at an increased risk of infection with CRE.

How to diagnose CRE?

Normally is diagnosed by blood tests called blood cultures. These blood cultures contain the bacteria responsible for infection. To demonstrate whether the organism is antibiotic resistant, a test is done called a drug sensitivity test (modified Hodge test).

It is done by  cleaning  the patient  skin and inserting a thin needle into your vein to draw your blood. The process will be repeated using another vein to get the most accurate results.

In a lab, your blood samples will get mixed with a special material called a culture. It helps bacteria or yeast grow if they are already in your blood.

You may be able to get early results within 24 hours of your blood tests. But you might need to wait 48 to 72 hours to learn what kind of yeast or bacteria is causing your infection. You might need other tests, too.

You may be able to get early results within 24 hours of your blood tests. But you might need to wait 48 to 72 hours to learn what kind of yeast or bacteria is causing your infection. You might need other tests, too.

How to treat CRE?

The increasing prevalence of CRE infections represents a major threat to human health. Effective antibiotics against CRE remain very limited, with polymyxins, tigecycline, fosfomycin, and aminoglycoside being the mainstays of anti-CRE therapy.

Here are some drug combinations.

Antibiotics such as aminoglycosides, polymyxin, tigecycline (Tygacil), fosfomycin (Monurol), and temocillin have been used with some success in the treatment of CRE infections.

CRE are resistant to most drugs. These germs make an enzyme that breaks down antibiotics before they can work. That's why the strongest of those drugs, called carbapenems, may not cure the infection.

Prognosis

Without proper treatment, CRE infections can cause severe complications. If a person gets a CRE bloodstream infection, it can be fatal. CRE can cause sepsis, which reduces blood flow to the organs. A UTI could reach the kidneys and cause a kidney infection if a person does not receive treatment.

Carbapenem-resistant Enterobacteriaceae (CRE) cause approximately 13 100 infections, with an 8% mortality rate in the United States annually.

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