CDC warns health departments about need for CRE prevention

The Centers for Disease Control and Prevention (CDC) reported that carbapenem-resistant Enterobacteriaceae (CRE) has increased over the last decade and most cases of resistance are associated with healthcare exposures. To slow the dissemination of CRE infections, local and state health departments need to take the lead in prevention efforts, according to CDC’s Morbidity and Mortality Weekly Report released on March 5.

CRE have been reported in healthcare settings as a difficult infection to treat with high rates of mortality (40% to 50%). During the first half of 2012, 4.6% of acute-care hospitals reported CRE cases. Of these, 145 acute-care hospitals for short stays (3.9%) and 36 long-term care hospitals (17.8%) reported one or more infections with CRE among almost 4,000 acute-care hospitals in the United States that performed surveillance. Hospitals in the Northeast and those that were larger and teaching hospitals were more likely to report CRE.

The CRE isolates reported in 2001 included Klebsiella pneumoniae and oxytoca, Escherichia coli, and Enterobacter aerogenes and cloacae. The CRE isolates in 2011 included Klebsiella pneumonia, Escherichia coli, and Enterobacter aerogenes and cloacae. The Klebsilla species had the largest increase in CRE isolates from 2001 to 2011, from 1.6% to 10.4%.

In the hospital, the most common source for CRE was urine (almost 90%) and then blood at 10%. While most of the isolates were collected from cultures outside of the hospital, most of the community-associated CRE isolates had recently been exposed in a healthcare setting, the report noted.

Invasive infections with CRE, such as bloodstream infections, were the most dangerous, resulting in mortality rates of 40% or more.

Efforts to control multi-drug resistant organisms have been very successful in the past.

“State and local health departments are well positioned to lead CRE control efforts because of their expertise in surveillance and prevention and their ability to interact among all the healthcare facilities in their jurisdiction,” the report stated. “Six states have made CRE reportable, and three additional states are actively pursuing this option.”