Carbapenem-Resistant Enterobacteriaceae Infection

Contact Precautions

Carbapenem-resistant Enterobacteriaceae (CRE) are gram-negative bacteria, such as Klebsiella pneumoniae and Escherichia coli, that produce the enzyme carbapenemase. The enzyme carbapenemase makes these bacteria resistant to nearly all antibiotics and increases the risk for dissemination. Carbapenem-resistant K. pneumoniae is the most common species seen in the United States, followed by carbapenem-resistant E. coli. CRE are associated with increased mortality in patients who have prolonged hospitalizations and in critically ill patients with invasive devices, such as central venous catheters, indwelling urinary catheters, and endotracheal tubes.

Causes

CRE enter health care facilities through a colonized or infected patient or colonized health care worker. CRE are transmitted mainly through person-to-person contact and from patient to patient through the hands of health care workers. CRE have become prevalent with the overuse of antibiotics, which has given bacteria the chance to develop defenses—such as carbapenemase—against antibiotics.

Complications

Complications associated with CRE infection include sepsis, multisystem organ failure, and death.

Assessment Findings

Some patients are colonized with CRE; they carry the bacteria but remain asymptomatic. Others become infected and develop signs and symptoms. Systemic infection produces chills, fever, tachycardia, and hypotension. Other signs and symptoms depend on the site of infection:

Lungs—Tachypnea; crackles on auscultation; rusty, viscous sputum (if K. pneumoniae is the causative organism); cough; fever; and hypoxemia
Urinary tract—Fever, urgency, frequency, dysuria, and suprapubic tenderness
Wound—Purulent drainage, erythema, swelling, warmth, fever, and malaise

Diagnostic Tests