CRE - short for carbapenum-resistant Enterobacteriaceae - are a family of bacteria that have developed extremely high levels of resistance to antibiotics. They are commonly referred to as a nightmare superbugIn fact, CRE bacterial infections are among the most deadly and dangerous because they are resistant to multiple classes of antibiotics, most notably Carbapenem (a broad spectrum antibiotic that is often considered the last line of defense for bacterial infection).
The two most common types of CRE infection are Escherichia coli (E. Coli) and Klebiella Pneumoniae - although Enterobacter and Salmonella have now shown resistance to carbapenems as well. However, both bacteria produce very similar problems and symtoms for those infected, that they are generally grouped together by investigators and healthcare workers.
CRE bacteria produce an enzyme called carbapenemase (Klebsiella pneumonia carbenemase - KPC and NDM New Delhi metal-beta-lactamase or NDM) that prevents carbapenems from killing bacteria and thus unable to treat infection.
Carbapenum-resistant Enterobacteriaceae can cause a wide variety of infections in the body from invasive bloodstream infections to gastrointestinal illness to infection of other body organs. They can also cause infections in the unitary tract - especially when a catheter is present -, intra-abdominal abscesses, and ventilator associated pneumonia. What’s worse is, due to the antibiotic resistant nature of CRE bacteria, CRE infections can kill up to 50% of patients who get a bloodstream infection from them. Patients typically get high fevers, chills, lethargy, and sores that do not heal, especially when treated with other antibiotics.
As of now, CRE bacteria are typically considered HAI’s and are only transmitted in health care settings. CRE are most often transmitted on the hands of healthcare personnel or through contaminated medical equipment. Most recently, several CRE outbreaks have been linked to contaminated duodenoscopes used in ERCP procedures.
Any patients in a health care setting are at an elevated risk of being infected or colonized with CRE bacteria. However, those at the highest risk are those in intensive care units, long-term care settings, exposed to mechanical ventilation or catheters. Anyone who has undergone an ERCP procedure in the last 6 months at any hospital is also at a very high risk of being exposed. Once infected or colonized, age, heart disease, malignancy, reliance on mechanical ventilation, and ICU status have all been associated with higher levels of CRE infection mortality rate.
The sad but true answer is that there are very few treatment options for CRE infections. They are extremely resistant to many classes of bacteria. For focused infections, such as catheter or ventilator infections, removing the focus of the infection through device removal, debridement, or drainage is helpful. Amino glycosides, tigecycline, fosfomycin, temocillin, and polymyxins are among the only antibiotics that are used to CRE infections, however, there are several concerns these as treatment options including limited efficacy, toxicity, and increased resistance.
Experimental drugs are also being developed to find CRE infections, most notably ceftazidime-avibactam - which an FDA advisory committee has recommended be approved for patients who have no other treatment options.
There are very stringent standards and protocols that hospitals and healthcare providers adhere to in an attempt to stem the spread of CRE and other superbug bacteria. Hand washing, careful cleaning and disinfecting of medical equipment, and isolating patients who have been exposed or infected with superbug bacteria are only a few. However, sometimes protocols fail or medical equipment manufacturers make mistakes and the bacteria is spread.
The most important thing you can do as a patient is to ask questions. If you undergo a medical procedure and infection sets in, find out what kind? It could be Staph, MRSA, CRE, or any other number of Healthcare Associated Infections.
If you or a loved one have acquired a CRE superbug infection, the first thing you should do is follow your healthcare provider’s instructions. As stated before, CRE infections can be up to 50% fatal, so you may be fighting for your life.
Next, you need to contact an attorney. Since CRE infections are healthcare associated infections, you were infected as a result of a medical procedure. In some cases this may have been the result of hospital negligence, but in many others - and in almost all cases of CRE infections after an ERCP procedure - a medical device manufacturer may be at fault. In fact, lawsuits have been been filed on behalf of patients infected with CRE bacteria at UCLA’s Ronald Reagan Medical Center and Cedars Sinai Hospital in Los Angeles.