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Carbapenem Resistant Enterobacteriaceae (CRE) is a major topic in infection control. This family of gram-negative bacterium is nearly immune to the carbapenem class of antibiotics, which are considered the ‘drug of last resort’ for such infections. Death rates of 40-50% have been recorded per CDC.

First detected in 2001 in a single state (North Carolina), recent data shows identification in at least 42 other states to date. One study indicated as many as 30% of long term care facilities patients have CRE though not all patients are symptomatic.

Enterobacteria has commensal properties – meaning that one species may be able transmit advantageous properties to another species. Imparting resistance to antibiotic treatment from one species to another will obviously make treatment more difficult if not impossible in some cases.

Due to the ability of carbapenamase encoding plasmids to transfer resistance to other organisms, it is important to identify patients that are either infected or colonized with carbapenem-resistant Enterobacteriaceae (CRE) and place them in contact precautions.

One source indicated that CRE infections are endemic in several major U.S. population centers, including New York, Los Angeles and Chicago. While there is no reliable national data on the scope of the CRE problem, the CDC has urged states to track cases but only a few do so.

Wisconsin is one of only six states (Wisconsin, Colorado, North Dakota, Minnesota, Oregon and Tennessee) that require the reporting of CRE.

The CDC has issued recommendations for the prevention of CRE spread.

We would recommend that all Infection Preventionists read and review all articles from the CDC and note the extensive national coverage by media regarding this situation.

CDC – Clinician FAQs

CDC – 2012 CRE Toolkit

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