Carbapenem-Resistant Enterobacteriaceae (CRE), Bacteria and Infection
Author: Disabled World : Contact: Disabled World
Synopsis and Key Points:
Information regarding Carbapenem-Resistant Enterobacteriaceae bacteria commonly found nearly anywhere in the world.
The media has recently presented short yet worrying comments about new and dangerous bacteria. The bacteria have been provided with various names by the media such as, 'dangerous bacteria,' or, 'superbug 2014.' The majority of stories presented by the media have only a few minutes to explain to people what is in reality a complicated situation which involves bacterial adaptation to environmental pressures, genetics, as well as the impact on human populations that makes researchers and doctors worried. The Centers for Disease Control and Prevention (CDC) has named these types of bacteria, 'CRE bacteria,' which stands for, 'Carbapenem-Resistant Enterobacteriaceae.'
CRE, which stands for carbapenem-resistant Enterobacteriaceae, are a family of germs that are difficult to treat because they have high levels of resistance to antibiotics. Klebsiella species and Escherichia coli (E. coli) are examples of Enterobacteriaceae, a normal part of the human gut bacteria, that can become carbapenem-resistant. Some CRE bacteria have become resistant to most available antibiotics. Infections with these germs are very difficult to treat, and can be deadly - one report cites they can contribute to death in up to 50% of patients who become infected.
What Are CRE Bacteria
To be plain, these bacteria are members of related bacterial genera that are commonly found nearly anywhere in the world, often times colonizing humans and animals. The bacteria live in or on people and animals and their gastrointestinal tracts, mucosal surfaces and on some areas of the skin. CRE; however, has a unique genetic makeup that permits the bacteria to make a component that protect CRE bacteria from a powerful antibiotic known as, 'Carbapenem.'
The most notable genera that may share and even transfer this genetic trait to other members of the enterobacteriaceae are Klebsiella pnuemoniae and E. coli. Due to the fact that these bacteria generate similar issues for people, particularly difficulties with treatment, the majority of investigators place them together in a group and term them, 'CRE bacteria.' Similar types of components are termed, 'KPC,' and, 'NDM.' KPC stands for, 'Klebsiella pnuemoniae,' and NDM stands for, 'New Delhi Metallo-beta-lactamase.' Resistance to Carbapenem is not the only reason why these bacteria are considered to be dangerous.
Enterobacteriaceae genetics are complex and many genera and strains have genetic material that codes for resistance against several types of antibiotics. As a new strain develops resistance to an antibiotic, it not only becomes resistant to the antibiotic - the genes that confer resistance to one antibiotic become linked to one another. As a consequence, as different antibiotic resistance happens, the genetic material may become linked together and confer antibiotic resistance to several antibiotics in a single strain of bacteria. The bacteria are resistant to a number of antibiotics and are far more dangerous to people who might become infected than bacteria which are susceptible to antibiotics.
As people introduce new antibiotics they place survival pressure on bacteria. New antibiotics may pressure the bacteria to adapt in order to survive even the most powerful and new antibiotics. Bacteria survive by permitting those few bacteria that develop stable resistance components that are genetically coded, to replicate, and then pass on genetic antibiotic resistance to other bacteria.
The genetic ability is then again linked to other antibiotic resistant genetic material, something that results in dangerous bacterial strains that are resistant to several, if not all, types of antibiotics. The CRE bacteria involve this very process. Bear in mind - there are strains of CRE bacteria that can pretty easily transfer genetic information to other bacterial strains that do not have multiple drug resistance, yet might have the potential to be dangerous under some circumstances such as, 'enterotoxigenic E. coli.'
The outbreak of CRE bacteria is still fairly small, although it might not stay that way. The CDC and other researchers know that a number of strains of Enterobacteriaceae may be lethal and hard to treat, even without being resistant to most antibiotics. How much damage could E. coli do to people if it became a CRE bacterium through genetic transfer and kept its current pathogenic characteristics? The CDC and researchers have no desire to find out.
When a person becomes infected with a CRE bacterium the risk of death is fifty-percent - even with multiple antibiotic treatment and supportive measures. More pathogenic traits such as the ability to synthesize toxins like entero-toxins and easy transfer from person to person, means the bacteria could devastate large populations of people. Since there are very few medication companies developing new antibiotics, the survival advantage might tip in favor of the bacterial pathogens and not to the person who is infected and being treated with antibiotics.
Due to the fact that the current CRE outbreak is small and often times confined to nursing homes, hospital intensive care units and other treatment areas where the use of new and powerful antibiotics are most frequent, the CDC has developed a method of attack to keep CRE and other, similar bacteria away from the general population and to reduce the dangerous bacteria's chances for surviving and passing into these areas. The method follows and every health care worker is urged to participate in order to prevent widespread outbreaks of CRE and similar bacteria. Core measures for all acute and long-term care facilities include:
- Hand Hygiene
- Promote hand hygiene
- Ensure access to hand hygiene stations
- Monitor hand hygiene adherence and provide feedback
Contact Precautions in Acute Care
The CDC has suggested some precautions in relation to the provision of care in acute care settings. These precautions include the following:
- Educate health care workers about contact precautions
- Monitor contact precaution adherence and provide feedback
- Place people with CRE-colonization or infection on contact precautions
- No recommendation can be made for the discontinuation of contact precautions
- Develop laboratory protocols for notifying clinicians and inpatients about the potential CRE
- Pre-emptive contact precautions may be used for people who are transferred from high-risk settings
Long-term Care and CRE Precautions
The CDC suggests placing CRE-colonized or infected people who are at high-risk for transmission on contact precautions. Where people who are at lower risk for transmission are concerned, use standard precautions in the majority of situations. When available, CRE-colonized or infected people and the staff members who provide care for them should be grouped - even if they are housed in single rooms. If the number of single person rooms is limited, reserve the rooms for those with the greatest risk for transmission. Minimize the use of invasive devices.
Promote antimicrobial stewardship. Screen for CRE bacterial strains in people and high acuity areas such as in isolation rooms and intensive care units. The CDC also recommends that people who have been identified as having a CRE infection be bathed with two-percent chlorhexidine. Areas that treat or house CRE-infected people need to undergo strict decontamination treatments. Instruments that might be in contact, or used to diagnose or treat CRE-infected people should also undergo decontamination.
People have many dangerous microbial enemies. A number of researchers and health care workers think CRE bacteria might be just the first wave of others to come. The CDC is providing guidance to health care workers concerning how to potentially reduce or prevent a large-scale outbreak of CRE bacteria. It would be wise to agree with the CDC's suggestions.
Carbapenem-resistant Enterobacteriaceae appear to have been uncommon in the United States before 1992. Over the past 10 years, dissemination of Klebsiella pneumoniae carbapenemase (KPC) has led to an increase in the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in the United States. Healthy people usually do not get CRE infections - they usually happen to patients in hospitals, nursing homes, and other healthcare settings. Patients whose care requires devices like ventilators (breathing machines), urinary (bladder) catheters, or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are most at risk for CRE infections.
U.S. States with confirmed CRE cases caused by the KPC enzyme: ( Source CDC Feb. 2014 )
California (including CRE caused by the NDM enzyme, VIM enzyme, IMP enzyme)
Colorado (including CRE caused by the NDM enzyme)
District of Columbia
Georgia (including CRE caused by the NDM enzyme)
Illinois (including CRE caused by the NDM enzyme)
Kentucky (including CRE caused by the NDM enzyme, VIM enzyme)
Maryland (including CRE caused by the NDM enzyme)
Massachusetts (including CRE caused by the NDM enzyme)
Minnesota (including CRE caused by the NDM enzyme)
Missouri (including CRE caused by the NDM enzyme)
New York (including CRE caused by the NDM enzyme)
Oregon (including CRE caused by the NDM enzyme)
Pennsylvania (including CRE caused by the NDM enzyme)
Rhode Island (including CRE caused by the NDM enzyme)
Virginia (including CRE caused by the NDM enzyme)
Washington (including CRE caused by the NDM enzyme, VIM enzyme, IMP enzyme)
Wisconsin (including CRE caused by the NDM enzyme)
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