Carbapenem-resistant Enterobacteriaceae (CRE)

Enterobacteriaceae are a family of bacteria (germs) that commonly live in a person’s bowel without causing illness.

Carbapenems are powerful antibiotics used to treat serious infections. Some Enterobacteriaceae have become resistant to these antibiotics which means they are no longer effective in fighting any infections that may develop. These are referred to as carbapenem-resistant Enterobacteriaceae or CRE.

Sometimes these bacteria can spread outside of the bowel and cause infection, for example a urinary tract infection, wound infection or pneumonia.

In recent years, infections caused by CRE have become more common in overseas hospitals. These bacteria are currently very rare in Western Australian hospitals.

Who is most at risk of getting CRE infections?

People most at risk for getting CRE appear to be those who have been in a hospital in an overseas country.

People who get CRE often have serious medical conditions that have resulted in them:

• receiving multiple antibiotics
• undergoing complex surgery
• staying in an intensive care unit
• having medical devices placed within their body, for example urinary catheters, ventilators or intravenous catheters.

How is CRE spread?

CRE can be spread from person to person through contact with an infected or colonised person.

This is either directly from the hands of another person or indirectly from environmental surfaces or medical equipment that have become contaminated.

It is not spread through the air or by coughing or sneezing.

Signs and symptoms

There is no specific ‘CRE disease’.

The symptoms that develop with CRE infection are the ones you would get with any other bacterial infection such as:

• fever
• feeling generally unwell
• rapid pulse rate
• redness, swelling, pain or heat at a specific site.

In some cases CRE can enter the bloodstream, from either an existing infection such as an abscess or urinary tract infection or from a medical device such as a urinary catheter or intravenous catheter.

Symptoms of bloodstream infection are also not specific to CRE and can be the same as for other bacteria. Typically, signs and symptoms can include fever, shivering, and low blood pressure.

How do I know I have CRE?

People carrying CRE in their bowel or other body sites show no signs or symptoms and it is impossible to tell if a person has CRE by looking at them.

If infection is suspected then a doctor will take a swab or specimen of, for example, blood, or urine or sputum and send it to the laboratory for testing.

Treatment of CRE infections

There is no vaccination available to prevent you from acquiring CRE or treatment to eliminate CRE from your body. People colonised with CRE do not need to have any treatment or antibiotics.

If the CRE are causing infection, there are still some antibiotics that can be used.

What happens if you have CRE?

If CRE is found in a specimen taken from you while you are in hospital, your healthcare team will continue to provide the same level of care. However, some extra precautions will be taken:

• You will be moved to a single room.
• Everyone, including you and your visitors, will need to wash their hands or use an alcohol-based hand rub before entering or leaving your room.
• A sign will be placed on your door to remind others of the precautions they need to follow, for example, to wear a gown and gloves when providing care.
• An alert will be placed against your name in the hospital computer system that can be seen by all the metropolitan public hospitals in WA. This alerts staff at the time of future admissions that extra precautions are required.
• As there is no method for this information to be shared with WA country or private hospitals, residential care facilities or hospitals outside of WA, it is important you advise these health providers that you have acquired a CRE.

What about my family and visitors?

Your family and friends can visit you but to prevent the spread of CRE to other patients or the environment, it is important that all visitors:

• always follow hand hygiene practices before entering and leaving your room
• do not eat or drink in your room
• do not use your hospital bathroom.

When you return home

Good hand hygiene will help prevent your family and friends from getting CRE. You should always perform hand hygiene by washing your hands with soap and water:

• after using the bathroom
• before and after eating
• if you touch any wounds or medical devices that you may have, for example a urinary catheter or wound drain.

CRE can survive for long periods on environmental surfaces, for example toilets, table tops and chairs, so it is important to regularly clean your household. Your clothing can be washed in the usual manner, along with the rest of the household laundry.

If you go to another healthcare facility, visit another doctor or have home care services, you should tell them that you have a CRE.

How can the spread of CRE be prevented?

Early detection of people who carry CRE is essential to stop any spread. This is why we screen for CRE in WA hospitals.

If someone has a history of being in a hospital or residential care facility outside of WA in the last 12 months, a specimen to screen for CRE (either a stool sample or a rectal swab) will be taken from them when they are admitted to hospital.

More Information

• If you are in hospital, you can ask to speak to the infection prevention control nurse.
• See your doctor.
• Ring healthdirect Australia on 1800 022 222.

Remember

• Bacteria known as carbapenem-resistant Enterobacteriaceae (CRE) are resistant to some powerful antibiotics.
• CRE can spread from person to person through contact with infected people or people who carry the bacteria without it causing infection within themselves.
• Hand hygiene is a simple but very effective measure that stops the spread of germs.

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This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.