Emergence of Carbapenem-Resistant Enterobacteriaceae
The CDC is alerting clinicians about the need for additional prevention steps regarding carbapenem-resistant Enterobacteriaceae (CRE). CRE infections most commonly occur among patients who are receiving antibiotics and significant medical treatment for other conditions.
CRE are untreatable or difficult-to-treat multidrug-resistant organisms that are emerging in the United States. Of the 37 unusual forms of CRE that have been reported in the United States, the last 15 have been reported since last July 2012. The majority of these unusual organisms were isolated from patients who received overnight medical treatment outside of the United States.
The current CDC guidance includes key elements on the prevention of CRE (eg, contact precautions, healthcare facility transfer protocol, etc.). In addition to that guidance, the CDC now also recommends:
- When a CRE is identified in a patient (infection or colonization) with a history of an overnight stay in a healthcare facility (within the last 6 months) outside the United States, send the isolate to a reference laboratory for confirmatory susceptibility testing and test to determine the carbapenem resistance mechanism; at a minimum, this should include evaluation for KPC and NDM carbapenemases.
- For patients admitted to healthcare facilities in the United States after recently being hospitalized (within the last 6 months) in countries outside the United States, consider each of the following:
- Perform rectal screening cultures to detect CRE colonization.
- Place patients on Contact Precautions while awaiting the results of these screening cultures.