What is it?

Enterobacterales is the name given to a family of bacteria that normally lives in the human gut. Some of these bacteria produce enzymes, called carbapenemases, which stop antibiotics from working against the bacteria. Bacteria that produce these enzymes are resistant to most types of antibiotics. 

Carbapenem resistance among Enterobacteriaceae is complex as it includes more than 70 different genera and many different mechanisms can lead to carbapenem resistance.

The majority of people who acquire CRE are colonised rather than infected, therefore they do not become ill

The primary site of colonisation is the lower gastrointestinal tract

The duration of colonisation is unknown but is possibly life-long

CRE can survive on environmental surfaces and equipment

Carbapenemase-producing Enterobacteriaceae (CP-CRE) 

These are another form of Enterobacteriaceae that carry a carbapenemase gene. They are a particular infection prevention and control risk because they are difficult to treat and can be more readily transmitted between residents within a facility and have caused a number of outbreaks overseas.

CPE can cause wound infections, pneumonia, urinary tract infections and bloodstream infections (sepsis), etc.

What are the symptoms?

Infections with CRE cause different symptoms depending on the part of the body affected. 

Some general symptoms of a CRE infection include

Cough

Fever

Shortness of breath

Nausea and vomiting

Chills

Low blood pressure

Transmission

CRE is transmitted through

Touching unclean medical equipment or surfaces

Poor hand hygiene

Having contact with stools without protection

Making contact with wounds without protection, including open wounds following surgery

If standard and transmission-based contact precautions are not followed staff providing direct care to these residents are at increased risk of transient acquisition of CRE on their hands.

CPE can spread between people through unwashed hands, or from contact with contaminated surfaces and medical equipment, and through the stools or wounds if someone has an infection. 

Diagnosis

The Doctor will order blood or urine samples if they suspect a resident has a CRE infection. The laboratory test will confirm the type of bacteria and determine if the bacteria is resistant to antibiotics.