What All Nurses Need to Know About CREIn today’s medical world, bacteria that cause simple urinary tract infections are developing resistance to once potent antibiotics such as Cipro and Bactrim. Let’s face it: as antimicrobial therapy changes, so do the bacteria. With the recent exposure of CRE bacteria at a local Los Angeles hospital during endoscopic procedures, resistant bacteria, or ‘superbugs’ have sparked recent news headlines. 

So What are CRE and How Do They Affect Nurses?

Carbapenem-Resistant Enterobacteriaceae are gram-negative bacteria, which include species of Klebsiella, Proteus, Echerichia (such as E.coli), and Enterobacter.

A patient is considered to be infected with CRE resistance when those bacteria are resistant to all third-generation cephalosporins (think Ceftriaxone, Cefotaxime, and Ceftazidime) and at least one Carbapenem (Doripenem, Ertapenem, Imipenem, Meropenem).  

Who is at Risk? 

Patients in a hospital with a prolonged length of stay, sharing a room, staying in a medical ICU setting, having a recent surgery, mechanical ventilation, exposure to antimicrobial therapy, or other invasive hospital procedures are at risk to acquire CRE.

Treatment of infections due to CRE is extremely difficult. Antibiotic choices are very limited and can have toxic side effects. These effects can include irreversible nephrotoxicity and neurotoxicity.

The Centers for Disease Control (CDC) report mortality rates are as high as 40-50% (2013) in some CRE cases. With antibiotic resistance on the rise, the development of new antimicrobials and appropriate stewardship in prescribing antibiotics are imperative as medical care advances. (We know nurses are begging doctors to give us a Z-Pack before a vacation, just in case!)

Early recognition of CRE infection or colonization is very important. 

Placing patients with CRE on contact precautions, hand washing, and appropriate disinfecting of medical equipment is necessary to prevent the transmission of CRE.  

Is your hospital system educated on treating the "superbug?" In the comments, tell us the precautions your unit is taking.

References

Centers for Disease Control.  (2013). Vital signs: carbapenum-resistiance enterobacteriaceae.  Retrieved March 2, 2015 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6209a3.htm.

U.S.Pharmacist: Health Systems Edition. (2013). Carbapenum-resistant enterobacteriaceae: An emerging threat. Retrieved March 3, 2015 from http://www.uspharmacist.com/content/c/45689/?t=pain_management,women%27s_health