Carbapenem-Resistant Enterobacteriaceae: New Precautions

Steven Fox

February 19, 2013

Citing increased reports of carbapenem-resistant Enterobacteriaceae (CRE), the Centers for Disease Control and Prevention (CDC) has expanded guidelines aimed at preventing the spread of these difficult-to-treat, multidrug-resistant organisms.

The guidelines were made available via a CDC Heath Advisory published online February 14, 2013.

"While still uncommon, reports of unusual forms of CRE (e.g., New Delhi Metallo-β-lactamase and Verona Integron-mediated Metallo-β-lactamase) in the United States are increasing," the advisory states. "Of the 37 unusual forms of CRE that have been reported in the United States, the last 15 have been reported since July, 2012."

Earlier recommendations for preventing spread of CRE center on the following precautions:

  • making sure healthcare providers adhere closely to hand hygiene procedures;

  • using stool, rectal, or perirectal cultures to screen patients who may have come into contact with CRE-colonized patients;

  • alerting receiving hospitals when a CRE-colonized patient is transferred;

  • dedicating rooms and staff to CRE patients whenever possible; and

  • removing temporary medical devices as soon as they have fulfilled their purpose.

In the latest advisory, the CDC notes that most CREs in the United States have been isolated from patients with a history of overnight treatment in medical facilities outside the country.

With that in mind, the advisory suggests expanding the recommendations as follows: "When a CRE is identified in a patient (infection or colonization) with a history of an overnight stay in a healthcare facility (within the last 6 months) outside the United States, send the isolate to a reference laboratory for confirmatory susceptibility testing and test to determine the carbapenem resistance mechanism; at a minimum, this should include evaluation for [Klebsiella pneumoniae carbapenemase] and [New Delhi Metallo-β-lactamase] carbapenemases," the advisory states.

In addition, the updated guidelines recommend that rectal screening cultures should be ordered for any patient admitted to healthcare facilities in the United States after being hospitalized within the previous 6 months in another country. Such patients should be placed on contact precautions until the results of the screenings are available.

For more information on prevention of CRE transmission see the CDC's CRE Toolkit.

"New Carbapenem-Resistant Enterobacteriaceae Warrant Additional Action by Healthcare Providers." CDC. Full text