Carbapenem-resistant Enterobacteriaceae (CRE), are a family of gram-negative bacteria that are difficult to treat because they have high levels of resistance to antibiotics including last-resort antibiotics called carbapenems. Although there are a large number of mechanisms that can lead to carbapenem resistance among Enterobacteriaceae, the production of an enzyme that breaks down broad-spectrum carbapenem antibiotics (carbapenemases) has emerged as an important mechanism in the United States over the last decade. Most carbapenemase-producing CRE in the United States produce a carbapenemase called Klebisella pneumoniae carbapenemase, or KPC, which was first reported in 2001.

Healthy people usually do not get CRE infections. In health-care settings, CRE infections most commonly occur among patients who are receiving treatment for other conditions. Patients whose care requires devices like ventilators (breathing machines), urinary (bladder) catheters, or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are most at risk for CRE infections. Infections with these organisms are very difficult to treat and can be deadly - one report cites they can contribute to death in up to 50 percent of patients who become infected.

Health-care providers need to act aggressively to prevent the spread of CRE organisms in their facility. The Centers for Disease Control and Prevention has developed a CRE toolkit with guidance for preventing the spread of CRE in health-care settings (www.ndhealth.gov/disease/cre/). The following are key recommendations that facilities should follow:

• Ensure that the patient is on contact precautions.

• Reinforce and evaluate adherence to hand hygiene and Contact Precautions for health-care personnel who come into contact with the patient (e.g., enter the patient’s room).

• Since clinical cultures will identify only a minority of patients with CRE, screen epidemiologically-linked patient contacts for CRE colonization with stool, rectal or perirectal cultures.

• Should the patient be transferred to another health-care facility, ensure that the presence of CRE colonization or infection is communicated to the accepting facility.

• Dedicate rooms and staff to CRE patients when possible. It is preferred that staff caring for CRE patients do not also care for non-CRE patients.

•  Remove temporary medical devices as soon as they are no longer needed.

For more information or to report cases of CRE, please call the NDDoH Division of Disease Control, at 701.328.2378 or 800.472.2180. Online reporting can be found at www.ndhealth.gov/disease/reportcard/.

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