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Gina Pugliese, RN, MS, editor
April 24, 2013


Detect and Protect: CDC's response to
increasing spread of CRE

To combat the increasing spread of real and deadly infections with carbapenem-resistant Enterobacteriaceae (CRE), the CDC has launched a new initiative - Detect and Protect. Unlike MRSA with treatment options, CRE is increasingly untreatable with no antibiotic options on the horizon now. Of concern are the high mortality rate for invasive infection and the potential for transfer of resistance genes to other bacteria. CDC has alerted all stakeholders-state public health officials, health care leaders, clinicians and patients-to the significant hazards of CRE and their role in laboratory detection and notification of clinicians and transferring facilities so protection-precautions can be taken for all patient care.

Time to contain is now!
Dr. Michael Bell, acting director of the Division of Healthcare Quality Promotion at CDC, believes it is possible to curb the CRE problem before it becomes more serious. "The good news is that CRE hasn't become common and widespread the way MRSA has, so the time to contain it is now. That's why CDC is taking such an aggressive approach to these pathogens. If we miss this window of opportunity, common infections could change from minor outpatient issues to life-threatening illnesses requiring hospitalization and desperate measures."

"...It is possible to curb the CRE problem before it becomes more serious…so the time to contain is now."
Dr. Michael Bell, acting director of the Division of Healthcare Quality Promotion
Center for Disease Control and Prevention

Ubiquitous, now resistant and lethal
Enterobacteriaceae are commonly found in the environment and the human digestive tract. Over the past decade some of these bacteria have developed resistance to carbapenems-antibiotics on which clinicians have relied in the past to combat these organisms. According to CDC, CRE have become a major source of infections that are difficult to treat and potentially lethal. Some studies have reported a mortality rate as high as 50% among patients with bloodstream infection.1-3 Although Enterobacteriaceae are ubiquitous, more than 90% of CRE infections occurred in patients with exposure to health care facilities, such as recent hospitalization.4 The proportion of Enterobacteriaceae that are resistant to carbapenem has increased almost four fold (1.2 percent in 2001 to 4.2 percent in 2011).4 The most frequently reported Enterobacteriaceae in the health care environment are Enterobacter species, Klebsiella species, and E. coli.5

Alarming evidence of spread
CRE are transferred easily between individuals and have the potential to spread widely across the country and internationally, raising concern that CRE may move from health care environments to the community. Because the organism is capable of transferring its resistance genes to other bacteria, its movement could vastly increase the pool of other bacteria resistant to currently available antibiotics.

You can't control what you don't know - Detect and Protect strategy
If we can't detect CRE in the laboratory and we are not alerted to its presence in a patient, we can't control it. CDC is focusing on a "Detect and Protect" strategy to prevent CRE from becoming a serious public health hazard. Detection involves using the correct tests to identify CRE in the clinical laboratory, alerting clinical staff immediately when CRE is detected and notifying receiving facilities when patients with CRE are transferred. Protection includes applying standard and contact precautions such as meticulous attention to environmental and hand hygiene for all CRE patient care. CDC has created a number of tools to help state officials, health care leaders, clinicians and patients take steps to stop the spread of CRE.




  1. Patel G, et al. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol. 2008;29:1099-106.
  2. Schwaber MJ, et al. Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis. 2011;52:848-55.
  3. Chitnis AS, et al. Outbreak of carbapenem-resistant Enterobacteriaceae at a long-term acute care hospital: sustained reductions in transmission through active surveillance and targeted interventions. Infect Control Hosp Epidemiol. 2012;33:984-92.
  4. CDC Vital Signs: carbapenem-resistant Enterobacteriaceae. MMWR 2013;62:165-70.
  5. Sievert DM, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the NHSN at CDC, 2009-2010. Infect Control Hosp Epidemiol. 2013;3


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