Carbapenem-resistant Enterobacteriaceae

Overview of Carbapenem-resistant Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae
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Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Fever, chills, infections
Complications	Sepsis, organ failure
Onset
Duration
Types	N/A
Causes	Bacterial infection
Risks	Hospitalization, antibiotic use
Diagnosis	Culture, susceptibility testing
Differential diagnosis	N/A
Prevention	N/A
Treatment	Limited antibiotic options
Medication	N/A
Prognosis	Variable
Frequency	Increasing
Deaths	N/A

Carbapenem-resistant Enterobacteriaceae (CRE) are a family of bacteria that are resistant to carbapenem antibiotics, which are often considered the last line of defense for treating severe bacterial infections. CRE infections are a significant concern in healthcare settings due to their high level of resistance and limited treatment options.

Overview

Enterobacteriaceae are a large family of Gram-negative bacteria that include many common pathogens such as Escherichia coli and Klebsiella pneumoniae. These bacteria can cause a variety of infections, including urinary tract infections, bloodstream infections, and pneumonia. Carbapenems are a class of broad-spectrum antibiotics that are typically used to treat severe or high-risk bacterial infections.

CRE are defined by their resistance to carbapenem antibiotics, which is often due to the production of enzymes called carbapenemases. These enzymes break down carbapenems and render them ineffective. The most common carbapenemases include KPC (Klebsiella pneumoniae carbapenemase), NDM (New Delhi metallo-beta-lactamase), and VIM (Verona integron-encoded metallo-beta-lactamase).

Epidemiology

CRE infections have been reported worldwide and are particularly prevalent in healthcare settings such as hospitals and long-term care facilities. The spread of CRE is facilitated by the movement of patients between healthcare facilities and the use of invasive devices such as catheters and ventilators.

Clinical Manifestations

CRE can cause a range of infections, including:

• Urinary tract infections
• Pneumonia
• Bacteremia
• Wound infections

Patients with CRE infections may present with symptoms such as fever, chills, and signs of sepsis. The infections can be severe and are associated with high morbidity and mortality rates.

Diagnosis

The diagnosis of CRE infections involves:

• Culture of the bacteria from clinical specimens
• Antimicrobial susceptibility testing to confirm resistance to carbapenems
• Molecular testing to identify specific carbapenemase genes

Treatment

Treatment options for CRE infections are limited due to their resistance to multiple antibiotics. Options may include:

• Combination therapy with antibiotics such as polymyxins, tigecycline, and aminoglycosides
• Use of newer antibiotics like ceftazidime-avibactam or meropenem-vaborbactam

Prevention

Preventing the spread of CRE involves:

• Strict adherence to infection control practices in healthcare settings
• Surveillance and screening of high-risk patients
• Antimicrobial stewardship programs to minimize unnecessary antibiotic use

Prognosis

The prognosis for patients with CRE infections varies depending on the site and severity of the infection, the patient's underlying health conditions, and the availability of effective treatment options. CRE infections are associated with high mortality rates, particularly in cases of bloodstream infections.

Also see

• Antimicrobial resistance
• Nosocomial infection
• Beta-lactamase
• Infection control