Carbapenem-resistant Enterobacteriaceae (CRE) are bacteria that have developed resistance to carbapenems, powerful antibiotics. This resistance makes CRE infections difficult to treat, posing a significant public health concern and leading to severe, challenging illnesses.
Understanding Carbapenem-Resistant Enterobacteriaceae
Enterobacteriaceae are a large family of bacteria commonly found in the human gut, including familiar types such as E. coli and Klebsiella species. While many of these bacteria are harmless residents, they can cause infections if they spread to other parts of the body. Carbapenems are a class of broad-spectrum antibiotics often reserved for treating severe bacterial infections, including those resistant to other drugs. They work by preventing bacteria from forming their cell walls.
Resistance to carbapenems is concerning because these antibiotics are considered last-resort treatments for many multidrug-resistant infections. CRE are not a single type of bacteria but rather various Enterobacteriaceae that have acquired this resistance trait, often by producing enzymes that inactivate carbapenems. This resistance can spread rapidly among different bacteria.
How CRE Spreads and Who is Most Vulnerable
CRE primarily spread through direct contact with infected or colonized individuals in healthcare settings. This can occur through contact with bodily fluids such as blood, urine, stool, or wound drainage. Indirect contact is also a mode of transmission, involving contaminated medical equipment or environmental surfaces like bed rails and doorknobs. Unlike some other pathogens, CRE are not spread through the air.
Certain populations face a higher risk of CRE infection. Patients in healthcare facilities are particularly vulnerable, especially critically ill patients or those with prolonged hospital stays. Individuals with weakened immune systems, those receiving long courses of antibiotics, or patients with indwelling medical devices like ventilators, urinary catheters, or intravenous catheters also have an increased risk. It is important to distinguish between colonization, where a person carries the bacteria without symptoms, and an active infection, where the bacteria cause illness.
Identifying CRE Infections
CRE can cause a range of infections throughout the body. Common types of infections include urinary tract infections, pneumonia, bloodstream infections, and wound infections. Symptoms may include fever, chills, difficulty breathing, cough, abdominal pain, or pain during urination. Redness, swelling, or itching at a surgical or injury site can also indicate a CRE infection.
Diagnosing a CRE infection typically involves laboratory tests of bodily fluids or tissues. Healthcare providers may collect samples of blood, urine, stool, or fluid from a wound for analysis. Further tests are performed to determine if the identified bacteria are resistant to carbapenems and other antibiotics, guiding effective treatment.
Treating CRE Infections
Treating CRE infections presents significant challenges. These infections often require the use of less common or older antibiotics, sometimes in combination. Treatment decisions are complex, taking into account the specific CRE strain, the infection site, and the patient’s overall health condition. Specialized infectious disease expertise is usually involved in managing these cases.
In some instances, CRE strains may be resistant to nearly all available antibiotics. In such severe cases, supportive care, such as fever-reducing medications or nutritional therapy, may be provided to help the body fight the infection. Newer antibiotic combinations have been developed to target certain types of CRE, offering additional therapeutic possibilities.
Preventing the Spread of CRE
Preventing the spread of CRE relies on stringent infection control measures, particularly within healthcare facilities. Healthcare personnel must practice meticulous hand hygiene, including washing hands with soap and water or using alcohol-based hand sanitizer before and after patient contact. Implementing contact precautions, such as wearing gowns and gloves when caring for CRE patients, and thorough environmental cleaning of high-touch surfaces are also essential. Removing medical devices like catheters as soon as they are no longer necessary helps reduce infection risk.
Patients and visitors also play a role in prevention. Frequent handwashing is important, especially after using the restroom or having contact with bodily fluids. Patients should inform healthcare providers about any recent hospitalizations or international travel. For the general public, responsible antibiotic use is a broader strategy to combat antibiotic resistance overall. This includes taking antibiotics only when prescribed and completing the full course as directed, rather than using them for viral infections or sharing them.