Carbapenem-resistant Enterobacteriaceae (CRE) Infection
Carbapenem-resistant Enterobacteriaceae (CRE) are types of bacteria. They can cause infections. These infections can be hard to treat. CRE got their name from the fact that they are resistant to carbapenems. Carbapenems are a type of antibiotic medicine.
Healthy people usually do not get a CRE infection. Patients in hospitals have the highest risk for a CRE infection. Those who are already very ill are more at risk. People of all ages can become infected with CRE. There are different types of bacteria that are all called CREs. One example is Klebsiella pneumoniae. These bacteria cause a lung, wound, or urinary infection.
Understanding antibiotic resistance
Antibiotic medicine is used to kill some types of bacteria. There are many kinds of antibiotics. Over time some bacteria may no longer respond to them. This is known as antibiotic resistance. For many years bacteria have shown resistance to common types of antibiotics. Doctors often then used carbapenems to kill these germs. But now this does not work on many types of CRE bacteria.
An overuse of antibiotics has helped cause the growth of bacteria such as CRE. If you have an infection from bacteria, you may take an antibiotic. The medicine will work if you have a strain of the bacteria that is not resistant. But a few bacteria may survive. They may acquire new genes. These new genes can allow them to resist the antibiotic . These resistant bacteria may then spread. They may cause an infection that is hard to treat.
Risks for CRE infection
Certain things may make it more likely that you will get a CRE infection. These include:
A recent stay in the hospital, especially one where CRE has been found
A stay in a long-term care facility
Use of antibiotics
Recent organ or stem-cell transplantation
Being on a breathing machine (mechanical ventilator)
Use of medical devices inside the body, such as a urinary catheter
Other things may raise the risk for death from a CRE infection. These include other serious illnesses. Older adults and very young children are most at risk of dying from CRE infections.
Symptoms of CRE infection
Symptoms of a CRE infection vary. They may differ because of the type of the bacteria and the site of the infection. Symptoms may include:
Fever, chills, and tiredness
Shortness of breath if you have pneumonia
Pain with urination if you have a urinary tract infection
Pain and swelling of the skin if you have a skin or wound infection
Belly pain if you have a liver or spleen infection
Stiff neck and reduced consciousness if you have infection of the tissues around the brain and spinal cord (meninges)
Diagnosing a CRE infection
Your healthcare provider will ask about your past health and your symptoms. You will be given a physical exam. You may have some tests. These depend on your symptoms. Tests may include:
Blood tests to check for signs of infection and anemia
Chest X-ray to check for lung infection
Urine test to check for urinary infection
Other imaging tests as needed
Blood culture test to see if bacteria are present in your blood
Sensitivity test to confirm if you are infected with CRE
Treatment for a CRE infection
Treatment depends on the type and site of the infection. Your treatment may include:
Careful watching of vital signs, such as heart rate
Medicines to reduce fever
Fluids given intravenously (IV)
Nutrition given by IV, tube, or mouth
Treatment of other health conditions
Breathing support with a ventilator, if needed
Treatment with other antibiotics
Possible complications of a CRE infection
Possible complications from CRE vary. They depend on the type and site of infection. For example, a lung infection from CRE may cause a pocket of bacteria and fluid (abscess) in the lung. Sepsis is a serious problem caused by CRE. It can lower blood flow to vital organs. It is a medical emergency, and may cause death.
Preventing a CRE infection
You can help prevent the spread of a CRE infection. These are some of the things you can do:
Always take all of your antibiotics as directed. Do not stop taking them if you feel better. Take them until they are gone. This can help prevent bacteria from becoming resistant to antibiotics.
Ask your healthcare team about removing possible sources of infection, such as a catheter.
Ask your healthcare providers to wash their hands before and after touching your body or any tubes that go into your body.
Wash your hands often.
October 08, 2017
Lentnek, Arnold, MD,Sather, Rita, RN