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Carbapenem-Resistant Enterobacterales (CRE)

Enterobacterales bacterium

Enterobacterales is an order of bacteria commonly found in the human digestive tract. There are several species of bacteria within the Enterobacterales order, which include, but are not limited to, Escherichia, Klebsiella, Enterobacter, Salmonella, Shigella, Citrobacter and Yersinia.

Many species of Enterobacterales are necessary for digestion and are usually harmless when contained in the digestive tract. However, these bacteria can cause serious infections when outside of the digestive tract.

Species of the Enterobacterales order may develop resistance to a group of antibiotics called carbapenems. These are called carbapenem-resistant Enterobacterales (CRE).

Carbapenems are often used as the last line of treatment when other antibiotics are not effective in treating Enterobacterales infections.

Healthy people do not usually get CRE infections. CRE infections are most common in patients in hospitals and long-term care facilities. People who are at higher risk for CRE infection include those who:

  • Require medical devices like ventilators or urinary catheters.
  • Take a long course of antibiotics.
  • Have weakened immune systems.

People can also be colonized with CRE. This means they have the bacteria in their body but do not show signs or symptoms of infection.

CRE is usually spread from person to person through contact with wounds or stool. This contact usually occurs via the hands or clothes of a health care worker, or through medical equipment that isn’t cleaned properly.

Steps health care facilities can take to prevent CRE from spreading:

  • When possible, place an infected or colonized patient in a private room with a bathroom and dedicate noncritical equipment to the patient.
  • Implement contact precautions when caring for patients infected or colonized with CRE. This includes wearing a gown and gloves.
  • For nursing home residents, implement enhanced barrier precautions.
  • Practice proper hand hygiene before and after contact with patients or their environment.
  • Prescribe and use antibiotics appropriately.

Steps patients can take to prevent CRE:

  • Ask health care providers to wash their hands before caring for you.
  • Frequently wash your own hands, particularly before caring for wounds, eating, and after using the restroom.
  • Take all antibiotics as prescribed.

CRE can cause infections in almost any part of the body including urinary tract infection, pneumonia, bloodstream infections, and intra-abdominal abscesses.

Carbapenem resistance can make these infections very difficult to treat. Treatment options for CRE infections are made on a case-by-case basis by a health care provider. People who are colonized with CRE often do not require treatment.

Resources

  • About CRE: CDC (Centers for Disease Control and Prevention) webpage with general information on CRE including tips on how to protect yourself
  • Tips for Being a Safe Patient: CDC webpage with tips for preventing healthcare-associated infections

As of April 25, 2022, carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) is a category II reportable communicable disease condition in Wisconsin. See the Reportable Multidrug-Resistant Organism webpage for additional information about communicable disease reporting for this organism.

CRE reporting in the National Healthcare Safety Network (NHSN) is no longer required for hospitals and nursing homes as of May 1, 2022, due to the availability of information about CRE cases in the Wisconsin Electronic Disease Surveillance System (WEDSS). For more information on reporting, visit the Reportable Multidrug-Resistant Organisms webpage.

Wisconsin Department of Health Services resources

CDC resources

Questions about CRE? Contact us.
Healthcare-Associated Infections Prevention Program website | Phone: 608-267-7711 | Fax: 608-266-0049 

Glossary

 
Last revised May 22, 2024