CDC Warns CRE Infections More Common, More Resistant

Its findings, published in Vital Signs, call on states, communities, medical facility CEOs, health care providers, and patients to take steps to prevent serious infections.

Drug-resistant germs called carbapenem-resistant Enterobacteriaceae, or CRE, have become more resistant to last-resort antibiotics during the past decade, a new report in CDC's Vital Signs indicates. The bacteria are causing more hospitalized patients to get infections that can be impossible to treat.

CRE germs kill one of every two patients who get bloodstream infections from them, and they readily transfer their antibiotic resistance to other bacteria. "For example, carbapenem-resistant klebsiella can spread its drug-destroying weapons to a normal E. coli bacteria, which makes the E.coli resistant to antibiotics also. That could create a nightmare scenario since E. coli is the most common cause of urinary tract infections in healthy people, according to the agency.

CDC has posted information about CRE and recommendations for participants in health care, including health care providers, workers, and patients who could be exposed. Colorado requires labs to report CRE and actively tracks the germs' presence, and it successfully stopped an outbreak by working with CDC and several affected facilities, the agency reported. CDC reported its personnel also helped Florida stop a yearlong CRE outbreak in a long-term acute care hospital, with the result that the percentage of patients who got CRE at the facility fell from 44 percent to zero.

Among its recommendations are these.

States and communities can:

  • Know CRE trends in your region.
  • Coordinate regional CRE tracking and control efforts in areas with CRE. Areas not yet or rarely affected by CRE infections can be proactive in CRE prevention efforts.
  • Require facilities to alert each other when transferring patients with any infection.
  • Consider including CRE infections on your state's Notifiable Diseases list.

Health care CEOs/medical officers can:

  • Require and strictly enforce CDC guidance for CRE detection, prevention, tracking, and reporting.
  • Make sure your lab can accurately identify CRE and alert clinical and infection prevention staff when these germs are present.
  • Know CRE trends in your facility and in the facilities around you.
  • When transferring a patient, require staff to notify the other facility about infections, including CRE.
  • Join or start regional CRE prevention efforts, and promote wise antibiotic use.

Health care providers can:

  • Know whether patients with CRE are hospitalized at your facility and stay aware of CRE infection rates. Ask whether your patients have received medical care somewhere else, including another country.
  • Follow infection control recommendations with every patient, using contact precautions for patients with CRE. Whenever possible, dedicate rooms, equipment, and staff to CRE patients.
  • Prescribe antibiotics wisely (http://www.cdc.gov/getsmart/healthcare). Use culture results to modify prescriptions if needed.
  • Remove temporary medical devices as soon as possible.

Patients can:

  • Tell your doctor if you have been hospitalized in another facility or country.
  • Take antibiotics only as prescribed.
  • Insist that everyone wash their hands before touching you.

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