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CRE are bacteria of the Enterobacteriaceae family, including Klebsiella pneumoniae and Escherichia coli (E. coli), that are non-susceptible to the carbapenem class of antimicrobials. Carbapenems are broad spectrum antibiotics that can be used to treat infections caused by bacteria resistant to other antibiotics. Patients who have devices such as catheters and ventilators or who are taking antibiotics are at highest risk of becoming infected with CRE. There are currently few antibiotic options for treating CRE infections. Invasive CRE infections have been associated with >40% mortality.

CRE are highly transmissible in healthcare settings and have been identified throughout the United States. Patients colonized or infected with CRE can serve as reservoirs that facilitate the spread of CRE within a healthcare facility and across the continuum of care. Carbapenem resistance also has the potential to spread to bacteria that commonly cause community-acquired infections, e.g. E. coli.

While the HAI Program’s 2012 California CRE Prevalence Survey found overall low prevalence of CRE in California as compared with other regions of the United States, there was higher prevalence in long term acute care (LTAC) facilities and geographically in southern California. A majority of healthcare facilities reported not performing CRE screening cultures to identify CRE-colonized patients. To prevent CRE from becoming widespread in California, collaboration is needed among healthcare providers, facilities, and public health.

California healthcare facilities and providers should:

· Be aware of CRE prevalence in their facility and region

· Ensure their laboratory can identify CRE and has protocols in place to immediately alert clinical and infection prevention staff when CRE are identified

· Implement contact precautions for patients colonized or infected with CRE. Wherever possible, dedicate rooms, equipment and staff for patients with CRE, and ensure thorough cleaning and disinfection of the environment

· Perform CRE screening cultures to identify unrecognized CRE colonization among epidemiologically linked contacts of known CRE colonized or infected patients (CDC Laboratory Protocol for Detecting CRE)

· Communicate with other healthcare facilities when transferring or receiving patients with CRE (CDPH Interfacility Infection Control Transfer Form)

· Prescribe antibiotics appropriately, and promote antimicrobial stewardship (CDPH Antimicrobial Stewardship Programs Project)

· Discontinue devices (e.g. central venous catheters, urinary catheters) as soon as no longer necessary

· Participate in facility-based and regional efforts to prevent transmission of CRE

· Notify their local health department of CRE clusters or outbreaks

California public health partners should:

· Be aware of CRE trends in their regions

· Know whether hospital or commercial laboratories used by their region’s healthcare facilities can accurately identify CRE and perform CRE screening cultures

· Understand and promote CDC and CDPH guidance for CRE detection and prevention, including the appropriate performance of CRE screening cultures, use of CDPH Interfacility Infection Control Transfer Form, and Antimicrobial Stewardship Programs

· Participate in regional CRE prevention efforts

California CRE Prevalence Survey, 2012

Guidance for healthcare facilities and recommended public health actions are stratified by regional CRE prevalence for 1) regions for no or rare CRE, 2) regions with few CRE, and 3) regions with common CRE, although no such region yet exists in the state. Please follow the links below to the slide presentations for each region types and a summary overview of CRE in all regions.
*Windows Media Player is required to view the webinars.


The CDC's 2012 CRE Toolkit - Guidance for Control of CRE

The CDC's Vital Signs - CRE

The CDC's CRE in Healthcare Settings website


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Last modified on: 6/8/2016 12:01 PM