Things to know about Carbapenem-resistant Enterobacteriaceae

Enterobacteriaceae are bacteria found in a healthy gastrointestinal tract. However, if these bacteria move to other parts of the body they can cause serious infections.

Carbapenems are powerful antibiotics used by doctors to treat severe infections of bacteria. Some Enterobacteriaceae and most other common antibiotics are resistant to carbapenems. These are called Enterobacteriaceae Resistant to Carbapenem (CRE).

Their antibiotic resistance can make CRE infections difficult to treat.

This article examines the symptoms of infections linked to CRE and how CRE is transmitted. This even looks at how doctors diagnose a CRE infection and treat it.

Infection symptoms

A man having pneumonia
CRE can cause pneumonia, infections of the bloodstream, and UTIs.

CRE can cause a wide range of infections, including:

  • pneumonia
  • bloodstream infections
  • urinary tract infections (UTIs)
  • wound infections
  • meningitis

Some common CRE signs include fever and a fast pulse. Certain signs depend on what form of infection a person has.

Signs of pneumonia can include, for example:

  • cough
  • fever
  • shortness of breath
  • nausea and vomiting

Bloodstream infection symptoms may include:

  • fever
  • chills
  • low blood pressure

UTI symptoms may include:

  • a frequent need to urinate
  • blood in the urine or cloudy urine
  • painful urination
  • urine that has a bad smell

Wound infection symptoms may include:

  • redness and swelling around the wound
  • pus
  • increased pain or heat around the wound

Meningitis symptoms may include:

  • nausea and vomiting
  • headache
  • a stiff neck
  • fever and chills
  • sensitivity to light

Depending on the type of Enterobacteriaceae the symptoms of a CRE infection can occur days or weeks after exposure to the bacteria.

Transmission

Once their bodies are either colonized or infected with the bacteria, people can pass on CRE. Colonization with CRE means people have CRE inside their bodies or on their skin but have no infection symptoms.

If someone has an infection with CRE the bacteria can move through contact with stools or wounds to others. In particular, CRE can pass between persons when they:

  • come into unprotected contact with stools
  • come into unprotected contact with wounds, including open wounds after surgery
  • touch unclean medical equipment or surfaces
  • have unclean hands

CRE can not pass through the air, so a person can not get a CRE infection without a contaminated object or body fluid coming into contact with it.

Some groups are more vulnerable to CRE infections, including those who:

  • are using urinary or intravenous catheters
  • require long-term hospital stays
  • are using ventilators
  • are using antibiotics long-term
  • have a weakened immune system
  • have a chronic health condition

CRE infections are uncommon among people in good health according to Centers for Disease Control and Prevention (CDC). Exposure to CRE in many cases does not lead to an infection..

Diagnosis

If a doctor thinks a person has a CRE infection, a sample of their body fluid, such as blood or urine, will be taken to a laboratory for examination.

The laboratory check will identify the bacterial species and assess whether the bacteria are antibiotic resistant.

Treatment

Individuals with CRE inside their bodies but no infection can typically need no care.

If a person has an infection with CRE, the treatment will depend on the type in question. If the bacteria are not yet all-antibiotic resistant, other antibiotic medications may be successful.

If the CRE is resistant to most of the antibiotics available, a doctor will figure out the person’s best treatment plan.

If no antibiotics are effective, the doctor can prescribe treatments that will alleviate the symptoms and help the body fight off the infection. Such possibilities may include:

  • using medicines to reduce fever
  • trying nutritional therapy
  • closely monitoring heart rate and other vital signs
  • taking intravenous fluids
  • treating any other health conditions present
  • using a ventilator to aid breathing, if necessary
  • trying other antimicrobial treatments

Complications

CRE infections can cause severe complications without proper treatment.

If a person is infected with CRE bloodstream it can be fatal. CRE can cause sepsis, reducing the flow of blood to the organs.

If a person does not receive treatment, a UTI may enter the kidneys and cause a kidney infection.

If CRE triggers a lung infection, this can lead to a lung abscess that develops when pus forms in lung cavities. This is potentially life threatening.

Precautions

People may take some measures to help avoid an infection with CRE. That is particularly important for people in high-risk groups.

If a person receives or administers treatment in a hospital or other health-care facility, it is very important to maintain good hygiene habits to help prevent CRE infections.

Washing the hands thoroughly, and all medical equipment may help prevent transmission of CRE.

All healthcare workers and patients should ensure thorough cleaning of their hands:

  • before touching any food
  • before touching any part of the face, including the eyes, nose, and mouth
  • after using the restroom
  • after coughing, sneezing, or blowing the nose
  • before and after dressing any wounds or changing bandages
  • before and after handling medical equipment or tubes connected to the body

Also, people should:

  • Follow the exact instructions a doctor gives when taking antibiotics they have prescribed.
  • Question healthcare providers on what precautions are in place to prevent infections.
  • Stay up to date on all vaccinations to help prevent certain infections.
  • Tell a healthcare provider if they have received treatment from another healthcare facility, either in the United States or another country.
  • Only take antibiotics if a doctor prescribes them as necessary.
  • Never take antibiotics that belong to another person or that a doctor prescribed for a different or previous illness.
  • Tell their healthcare provider if they notice any new symptoms or unusual changes in their body, such as diarrhea or worsening symptoms.

Summary

CRE is a type of bacteria resistant to most of the antibiotics available, including strong antibiotics called carbapenems.

CRE infections include:

  • pneumonia
  • bloodstream infections
  • wound infections
  • UTIs
  • meningitis

Those who are in good general health are less likely to become diagnosed with CRE. Those with chronic health conditions or weakened immune systems, and those with long-term antibiotics, may be at greater risk. The use of catheters and ventilators also increases the risk of introducing bacteria into the body.

Antibiotic resistance can complicate therapy of CRE infections. Also, however, other antibiotics may be successful. Certain forms of treatment will help the body fight off the infection, too.

In all healthcare environments, maintaining good hygiene practices is a simple step that can help prevent CRE infections. Healthcare workers, visitors and patients should all take care to regularly and thoroughly wash their hands to help prevent infections.

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