Carbapenem-Resistant Enterobacteriaceae Infection: New Guidelines

Raymund Dantes, MD, MPH; Alice Guh, MD, MPH


June 21, 2012

Editorial Collaboration

Medscape &

Carbapenem-Resistant Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae (CRE) are a serious threat to public health. Infections with CRE are difficult to treat and have been associated with mortality rates as high as 40%-50%.[1] To protect patients and prevent transmission, healthcare professionals need to take specific steps.

Enterobacteriaceae, a frequent cause of both community- and healthcare-associated infections, can become resistant to carbapenems through various mechanisms, including the production of carbapenemases. Klebsiella pneumoniae carbapenemase (KPC) is the most common carbapenemase in the United States and has spread throughout many regions.

Although the prevalence of CRE likely varies from region to region, a review of data from the National Healthcare Safety Network found that in 2009-2010, about 13% of Klebsiella species reported from central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) were carbapenem-nonsusceptible. About 2% of Escherichia coli reported from CLABSIs and CAUTIs were carbapenem-nonsusceptible.

Genes coding for KPC can be transmitted between bacteria via mobile genetic elements, potentially facilitating transmission of these organisms. Metallo-beta-lactamase-producing organisms (NDM, VIM, and IMP) have also been identified in the United States but appear to be less common than KPC-producing organisms.[2]


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