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From the Premier Safety Institute®
Gina Pugliese, R.N., M.S., editor


Safety Share®

CDC guidance to fight Carbapenem-resistant Enterobacteriaceae (CRE) across healthcare


 
The emergence and dissemination of Carbapenem-resistant Enterobacteriaceae (CRE) throughout many parts of the United States represent a
serious threat to public health. These organisms are associated with high mortality rates, up to 40-50 percent, and have the potential to spread widely.
CRE appear to have been uncommon in the United States before 1992, however, most common are Klebsiella pneumoniae carbapenemase (KPC) that
have disseminated widely throughout the United States since being first reported in 2001.

CRE are resistant to multiple antibiotics and can spread easily

Due to the movement of patients throughout the healthcare system, if CRE are a problem in one facility, then typically they are a problem in other
facilities in the region as well. CDC’s surveillance definition of CRE is resistance to all of the following third-generation cephalosporins that were
tested: ceftriaxone, cefotaxime, and ceftazidime, all three being recommended as part of the primary or secondary susceptibility panels for
Enterbacteriaceae.

CDC special case report describes CRE with the New Delhi enzyme

CDC’s released a
special report in the MMWR that describes two cases of CRE containing the New Delhi
metallo-beta-lactamase (NDM) enzyme. CRE with NDM are of particular concern because these enzymes allow drug-resistance to be transferred easily from one
bacterium to another.

CDC website and toolkit for prevention

To help protect patients and prevent transmission, in June 2012, the CDC created a new
website on CRE and released a
CRE toolkit
which expands on 2009 CDC
recommendations and continues to be updated as new information becomes available.

Contact precautions, gown, gloves among steps to reduce CRE transmission

These new CDC resources provide key steps for patients, clinicians, healthcare facilities, and health departments, including:

  • Place patients currently or previously colonized or infected with CRE on
    Contact Precautions
  • Wear a gown and gloves when caring for patients with CRE
  • Perform hand hygiene – use alcohol-based hand rub or wash hands with soap and water before and after contact with patients or their environment
  • Prescribe and use antibiotics wisely
  • Discontinue devices like urinary catheters as soon as no longer necessary

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