Clinical Corner: CRE’s (Carbapenem-resistant Enterobacteriaceae)

by Joe Bryowsky RN, CCRN – Clinical Manager

There’s been a lot of talk in the news lately about CRE’s. This was precipitated when Dr. Thomas Frieden, Director of the CDC, made the statements that “CRE are nightmare bacteria” and “Our strongest antibiotics don’t work and our patients are left with potentially untreatable infections”.

But what are CRE’s and what precautions should healthcare workers take in reducing the spread of CRE’s?

CRE, which stands for carbapenem-resistant Enterobacteriaceae, are a family of germs that are difficult to treat because they have high levels of resistance to antibiotics. Enterobacteriaceae are a family of more than 70 bacteria which share the characteristic of being gut-dwelling (entero). They include Klebsiella, Salmonella, Shigella and E. coli. Carbapenems are a “last-resort” family of antibiotics (imipenem, meropenem, doripenem and ertapenemen.) which are used against these bacteria when they have become resistant to other drugs.

Healthy people usually don’t get CRE infections. Infections caused by CRE most commonly occur in people who have:

  • Chronic medical conditions
  • Recent prolonged stays in healthcare settings
  • Invasive devices such as ventilators, IV catheters, urinary catheters
  • History of taking certain antibiotics for long periods of time

Just when we thought super bugs like MRSA (methicillin-resistant staphylococcus aureus), VRE (vancomycin-resistant enterococci) etc. were bad enough with about a 20% mortality rate, we’re now seeing an increase in CRE’s, with about a 50% mortality rate, becoming ever more present in our healthcare settings!

Am I at risk in taking care of patients with carbapenem-resistant Enterobacteriaceae?

This type of infection generally occurs in more sick patients following long courses of broad spectrum antibiotics. As a healthy individual, you are not at risk of “catching” this type of infection. However, without taking proper infection control precautions, you are at risk of spreading carbapenem-resistant Enterobacteriaceae to other patients.

How can carbapenem-resistant Enterobacteriaceae infections be prevented in the healthcare


To prevent spreading CRE infections between patients, healthcare personnel must follow specific

infection control precautions (See: Guideline for Isolation Precautions: Preventing Transmission of

Infectious Agents in Healthcare Settings 2007 at www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf.

All patients colonized or infected with CRE should be placed on contact precautions. These

precautions include wearing gowns and gloves when they enter carbapenem-resistant


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About the Author

My name is Jeannie Holmes. I’m the Social Media and Brand Cultivator at Medical Solutions, one of the leading traveling nurse companies. I'm so happy to work at Medical Solutions and think it is an awesome company that has a lot to offer nurses interested in a travel career. I have never been a nurse and am not a recruiter. Have a great day!