Carbapenem-resistant Enterobacteriaceae (CRE) infections are unlikely to occur among healthy people, and instead are affecting individuals receiving medical care at hospitals, skilled nursing facilities, and long-term acute care centers.
In such facilities, CRE infections generate and pass from one sick person to another, generally by way of devices like intravenous and urinary catheters, breathing machines, and other equipment used by multiple patients. This rare yet deadly bacteria is therefore considered a healthcare-associated infection by the Centers for Disease Control and Prevention (CDC), and is only a risk for those receiving care in a medical setting.
While the rate of infection is a slim 4 percent with CRE bacteria, it has quadrupled over a matter of only ten years. One the infection reaches the bloodstream, as many as half of patients will die, as the CDC has observed. As the name suggests, the bacteria is impermeable by traditional antibiotics, including carbapenem, a medication designed for severe bacterial infections and used as a last resort. As carbapenems were considered the light at the end of the tunnel for powerful infections in the same Enterobacteriaceae family as CRE, such as E. coli and Klebsiella pneumoniae, the CRE resistance is especially frightening.
Entertobacteriaceae are found in normal human intestines, yet if they travel outside the intestines and into the bloodstream, major infections can ensue. Pneumonia, urinary tract infections, meningitis, and bloodstream infections are just a few examples of the illnesses commonly caused by CRE and other enterobacteriaceae, most of which are transmitted in healthcare settings and other locations where medical equipment is shared. As patients in these settings are already ill in most circumstances, they are more susceptible to becoming infected and experiencing serious health problems as a result.
Klebsiella pneumoniae is the largest concern from the spread of CRE infections, as it claimed seven lives in 2012 after an outbreak in the D.C.-area’s National Institutes of Health Clinical Center. Klebsiella pneumoniae carbapenemase (KPC) is an enzyme created by some CRE that break down carbapenems and render them useless. Several other enzymes have also been discovered which break down carbapenems and result in CRE growth, including NDM-1, IMP, and VIM, and are more rare in the U.S.
CRE Colonization, Infection, & Symptoms
In discussion of CRE bacteria, the risk and potential damage varies greatly when comparing those who are infected to those who have experienced colonization. The difference? When the organism is discovered on the body, yet it has not caused any symptoms, the bacteria has colonized. While this may sound safer than an infection, colonization of CRE strains can eventually lead to infection if they can enter typically sterile regions such as the bloodstream, bladder, or lungs.
CRE infections generally lead to symptoms affecting a specific area, such as a urinary tract infection if the bladder is infected, or a cough if the bacteria has infected the lungs. Additional symptoms may also occur, unrelated to any certain body part, including feelings of general illness such as fever, chills, and fatigue.
How the Infection Spreads
Medical equipment used in facilities serving large populations are the main source of CRE infections. The CRE bacteria spread from one infected person to another, most often through wound or stool contact. Wounds caused by injury or surgical procedures are equally as susceptible to infection as the use of medical devices such as catheters.
Treatment for CRE
As mentioned, the big stir caused by CRE is the bacteria’s resistance to treatment. Antibiotics usually prescribed for these sorts of infections have proven futile, though there may be hope with certain types of drugs. Doctors are working on a individual basis to establish the most effective treatment for each case, in a sort of trial-and-error period as the infection continues to spread. Those who are colonized may not require any treatment, but should still consult a medical provider regardless.
Utilizing Coverage For Infection or Concerns
Those who are likely to become infected must already have some form of health insurance if they’re in a healthcare setting. However, using your benefits to cover an unexpected infection caught while receiving care is essential. If you feel any symptoms of infection of any area, be it respiratory, urinary, gastrointestinal, or otherwise, contact your doctor immediately. If you are concerned after reading the reports of CRE infection after a hospital stay, visit your doctor for an exam to ensure you are safe from colonization or infection. A quick office visit is usually one of the least expensive services to diagnose and identify your health problem, and finding the right course of action by trying different antibiotics may help save your life.
1. 05 March 2013. Amina Khan. Los Angeles Times. CDC: Deadly, drug-defying CRE bacteria on rise in U.S. hospitals.
2. Centers for Disease Control and Prevention. General Information about CRE.
3. Centers for Disease Control and Prevention. Clinician Information about CRE.
4. Wikipedia. Carbapenem.
5. NBC News. More Bad News About ‘Nightmare Bacteria’, CDC Says.