Carbapenem-resistant Enterobacteriaceae (CRE) refers to Enterobacteriaceae bacteria that are resistant to strong antibiotics known as Carbapenems.
Enterobacteriaceae are bacteria that live in a healthy digestive tract. However, these bacteria can cause severe infections if they move to other parts of the body.
Carbapenems are strong antibiotics that doctors use to treat severe bacterial infections. Some Enterobacteriaceae are resistant to carbapenems, and most other common antibiotics. These are called Carbapenem-resistant Enterobacteriaceae (CRE).
Their resistance to antibiotics can make CRE infections challenging to treat.
This article examines the symptoms of CRE-related infections and how CRE is transmitted. It also looks at how doctors diagnose and treat a CRE infection.
CRE can cause a wide range of infections, including:
- bloodstream infections
- urinary tract infections (UTIs)
- wound infections
Some general symptoms of a CRE infection include fever and a rapid pulse. Other symptoms will depend on which type of infection a person has.
For example, pneumonia symptoms may include:
- shortness of breath
- nausea and vomiting
Bloodstream infection symptoms may include:
- low blood pressure
UTI symptoms may include:
- a frequent need to urinate
- blood in the urine or cloudy urine
- painful urination
- urine that has a bad smell
Wound infection symptoms may include:
- redness and swelling around the wound
- increased pain or heat around the wound
Meningitis symptoms may include:
- nausea and vomiting
- a stiff neck
- fever and chills
- sensitivity to light
The symptoms of a CRE infection may appear days or weeks after exposure to the bacteria, depending on the type of Enterobacteriaceae.
People can pass on CRE if their bodies are either colonized or infected with the bacteria. Colonization with CRE means that people have CRE inside their bodies or on their skin but have no symptoms of infection.
If someone has a CRE infection, the bacteria can pass to others through contact with stools or wounds. Specifically, CRE can pass between people if they:
- come into unprotected contact with stools
- come into unprotected contact with wounds, including open wounds after surgery
- touch unclean medical equipment or surfaces
- have unclean hands
CRE cannot pass through the air, so a person cannot get a CRE infection without coming into contact with a contaminated object or bodily fluid.
Certain groups are
- are using urinary or intravenous catheters
- require long-term hospital stays
- are using ventilators
- are using antibiotics long-term
- have a weakened immune system
- have a chronic health condition
If a doctor suspects that a person has a CRE infection, they will take a sample of their bodily fluid, such as blood or urine, to test in a laboratory.
The laboratory test will confirm the species of bacteria and determine if the bacteria are resistant to antibiotics.
People with CRE within their body but no infection will likely not need any treatment.
If a person has a CRE infection, treatment will depend on the specific type. If the bacteria are not yet resistant to all antibiotics, certain antibiotic treatments may be effective.
If the CRE are resistant to most available antibiotics, a doctor will work out the best treatment plan for the individual.
If no antibiotics are effective, the doctor may recommend treatments that relieve the symptoms and support the body in fighting off the infection. These options may include:
- using medicines to reduce fever
- trying nutritional therapy
- closely monitoring heart rate and other vital signs
- taking intravenous fluids
- treating any other health conditions present
- using a ventilator to aid breathing, if necessary
- trying other antimicrobial treatments
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.
If CRE cause a lung infection, it may progress to a lung abscess, which occurs when pus collects in cavities in the lungs. This can be life threatening.
People can take certain precautions to help prevent getting a CRE infection. This is particularly important for people within high risk categories.
If a person is receiving or administering treatment in a hospital or other healthcare facility, maintaining good hygiene practices is very important in helping prevent CRE infections.
Thoroughly washing the hands and all medical equipment can help prevent CRE transmission.
Both healthcare workers and patients should make sure to clean their hands thoroughly:
- before touching any food
- before touching any part of the face, including the eyes, nose, and mouth
- after using the restroom
- after coughing, sneezing, or blowing the nose
- before and after dressing any wounds or changing bandages
- before and after handling medical equipment or tubes connected to the body
Also, people should:
- Follow the exact instructions a doctor gives when taking antibiotics they have prescribed.
- Question healthcare providers on what precautions are in place to prevent infections.
- Stay up to date on all vaccinations to help prevent certain infections.
- Tell a healthcare provider if they have received treatment from another healthcare facility, either in the United States or another country.
- Only take antibiotics if a doctor prescribes them as necessary.
- Never take antibiotics that belong to another person or that a doctor prescribed for a different or previous illness.
- Tell their healthcare provider if they notice any new symptoms or unusual changes in their body, such as diarrhea or worsening symptoms.
CRE are a type of bacteria that are resistant to most available antibiotics, including strong antibiotics called carbapenems.
CRE infections include:
- bloodstream infections
- wound infections
People in good general health are less likely to get a CRE infection. Those with chronic health conditions or weakened immune systems, as well as those using antibiotics long-term, may be more at risk. Using catheters and ventilators also increases the risk of bacteria passing into the body.
Antibiotic resistance can make CRE infections more difficult to treat. Certain antibiotics may still be effective, though. Other treatment methods can also help the body to fight off the infection.
Maintaining good hygiene practices in all healthcare settings is a simple step that can help prevent CRE infections. Healthcare workers, visitors, and patients should all take care to wash their hands frequently and thoroughly to help prevent infections.