Symptoms, Treatment and Prevention of CRE: The Newest Superbug in Healthcare Settings

Carbapenem-resistant Enterobacteriaceae (CRE) is being touted as ‘nightmare bacteria’ and ‘killer bacteria,’ and rightfully so. According to the Centers for Disease Control and Prevention (CDC), the death rate for individuals who contract CRE may be as high as 50 percent. The CDC states that people within the general population are usually not at risk of contracting carbapenem-resistant Enterobacteriaceae; however, seniors who reside in nursing homes, patients in hospitals and residents in other healthcare settings are at risk of becoming infected with these extremely dangerous, antibiotic-resistant bacteria.

Patients Around the Globe Becoming Infected with CRE

Enterobacteriaceae are actually normal bacteria that have evolved and are capable of producing enzymes to combat the majority of the antibiotics that are currently available. These bacteria are infecting people all over the world, and the rate of infection continues to rise.

Carbapenem-Resistant Enterobacteriaceae is Spread Through Touch

Carbapenem-resistant Enterobacteriaceae are spread through touch. For instance, a nurse might touch an infected patient’s stool or wound and neglect to wash his or her hands. When the nurse cares for another patient, he or she may infect that patient with the CRE bacteria.

These bacteria are spread via contaminated surfaces as well. These surfaces include hospital and nursing home beds, medical tools and lavatory items: According to a systematic review, nosocomial pathogens like CRE can survive on inanimate surfaces for weeks, or even months.

Seniors Among the Patients at Highest Risk of Contracting CRE

The California Department of Public Health states that patients with compromised immune systems are at the greatest risk of becoming infected with CRE. These patients include those who are taking long courses of antibiotics, using ventilators, bladder catheters, vein catheters and those who undergo endoscopic procedures. Many carbapenem-resistant bacterial infections occur in nursing homes, hospitals and other healthcare facilities due to the use of improperly cleaned, and/or incorrectly sterilized medical tools.

Symptoms of a Carbapenem-Resistant Bacterial Infection

The symptoms a patient experiences depends on the organs that are involved (e.g., bladder or lungs, etc.) That said, although the symptoms of a carbapenem-resistant bacterial infection do vary, the majority of infected patients do experience chills and a fever.

Other symptoms may include:

• wounds that neglect to heal, nurses should pay close attention to wounds that do not heal after being treated with over-the-counter antibiotic creams or ointments;
• areas of redness, swelling or soreness beneath the skin that persists; and
• fatigue.

Diagnosis and Treatment

Once the patient’s blood culture results come back positive for CRE, an antibiotic regimen will be implemented. Very few antibiotics can kill carbapenem-resistant bacteria; hence, the high mortality rate.

The U.S. National Library of Medicine states that the few antibiotics used to treat CRE are:

• Temocillin
• Tigecycline
• Aminoglycosides
• Fosfomycin
• Polymyxins

Carbapenems were used as the ‘last resort’ antibiotic for treating gram-negative bacteria; nevertheless, CRE have now become resistant to these antibiotics. Thus, this treatment option is no longer viable. However, Actavis has developed an antibiotic to fight carbapenem-resistant bacteria: This antibiotic is ceftazidime-avibactam.

10 Tips for Preventing CRE Infections in Nursing Homes

Clearly, one of the key components to preventing CRE is cleanliness throughout the facility, in addition:

1. All medical supplies and equipment need to be cleaned scrupulously and properly sterilized prior to use.
2. Once devices are clean and sterile, to ensure they remain sterile, only properly trained personnel should handle them.
3. Surfaces throughout the nurses’ workstation, the patients’ rooms and lavatories need to be clean, and disinfected regularly.
4. Nurses should wear a gown and gloves prior to entering the room of a senior with CRE.
5. Nurses should remove their gown and gloves, and wash their hands thoroughly prior to exiting the room of a senior known to have CRE.
6. If possible, the nursing home or assisted-living facility should dedicate staff members and equipment to the seniors with carbapenem-resistant bacterial infections.
7. Before and after caring for each patient, nurses need to thoroughly wash their hands with soap and water or use an alcohol-based hand sanitizer.
8. Either, keep patients with carbapenem-resistant bacterial infections in a room with another patient who has a CRE or place the senior in a room by himself/herself.
9. When no longer needed, nurses should remove temporary medical devices from patients’ rooms promptly.
10. Antibiotic regimens need to be followed per the physician’s orders.

Limit Transmission Through Implementing Contact Precautions

To limit transmission, place residents with carbapenem-resistant Enterobacteriaceae bacterial infections and those seniors who are determined to be CRE colonized, and at a higher risk for transmitting the bacteria in contact precautions.

These residents include seniors who:

• Are entirely dependent on nurses for assistance with activities of daily living.
• Have wounds that continuously drain; thus, making controlling the drainage extremely difficult.
• Are receiving post-acute care and remain weakened due to a recent hospitalization.
• Are dependent on a ventilator.
• Cannot control their stool or urine: Their incontinence cannot be contained reliably.
• Are unkempt because they cannot maintain good personal hygiene.

According to the CDC, even if a patient is not displaying symptoms of CRE, he or she may still have the germ in or on their bodies: These patients are considered ‘colonized’ with carbapenem-resistant Enterobacteriaceae and they will not require antibiotics. For this reason, nurses need to remain vigilant in maintaining cleanliness and sterility throughout the nursing homes and assisted-living facilities where they work. It is important to note that the North Dakota Department of Health states that even an individual who has already had CRE can contract the infection again.