Carbapenem Resistant Enterobacteriaceae

What is Carbapenem Resistant Enterobacteriaceae (CRE)?

Enterobacteriaceae are a family of bacteria normally found in the bowels and the feces. Carbapenem is a very strong antibiotic. CRE are Enterobacteriaceae that are highly resistant to many antibiotics and may be difficult or impossible to treat. Some CRE have special genes that allow them to spread their resistance to other bacteria.

  • Unusual Antibiotic-Resistant Germ
  • Once antibiotic resistance spreads, it is harder to control-like a wildfire.
  • Finding and responding to unusual resistance early, before it becomes common, can help stop its spread and protect people.
  • New or rare types of antibiotic resistance can be easier to contain when found rapidly-like a spark or campfire.
  • Unusual Antibiotic-Resistant Germs
    • Resistant to all or most antibiotics tested, making them hard to treat, and
    • Uncommon in a geographic area or the US, or
    • Have special genes that allow them to spread their resistance to other germs.

Examples of unusual resistance: Vancomycin-resistant, Staphylococcus aureus (VRSA), Candida auris, and certain types of "nightmare bacteria" such as carbapenem-resistant Enterobacteriaceae (CRE).

    Who is most likely to get an infection with CRE?

    Healthy people usually don’t get CRE infections. CRE primarily affect patients in acute and long-term healthcare settings, who are being treated for another condition. CRE are more likely to affect those patients who have compromised immune systems or have invasive devices like tubes going into their body. Use of certain types of antibiotics might also make it more likely for patients to get CRE.

      How are CRE spread?

      To get a CRE infection, a person must be exposed to CRE germs. CRE germs are usually spread person to person through contact with infected or colonized people, particularly contact with wounds or stool. CRE can cause infections when they enter the body, often through medical devices like ventilators, intravenous catheters, urinary catheters, or wounds caused by injury or surgery.

        What if I have CRE?

        Follow your healthcare provider’s instructions. If your provider prescribes you antibiotics, take them exactly as instructed and finish the full course, even if you feel better. Wash your hands, especially after you have contact with the infected area and after using the bathroom. Follow any other hygiene advice your provider gives you.

          Do I need to take special precautions at home?

          Patients and people providing care at home should be careful about washing their hands, especially after contact with wounds or using the bathroom or after cleaning up stool. Caregivers should also make sure to wash their hands before and after handling the patient’s medical device (e.g., urinary catheters). This is particularly important if the caregiver is caring for more than one ill person at home. In addition, gloves should be used when anticipating contact with body fluids or blood.

            What are some things hospitals are doing to prevent CRE infections?

            To prevent the spread of CRE, healthcare personnel and facilities can follow infection-control precautions provided by CDC. These include:

              • Washing hands with soap and water or an alcohol-based hand sanitizer before and after caring for a patient
              • Carefully cleaning and disinfecting rooms and medical equipment with appropriate hospital grade cleaners and disinfectants
              • Wearing gloves and a gown before entering the room of a CRE patient
              • Keeping patients with CRE infections in a single room or sharing a room with someone else who has a CRE infection
              • Whenever possible, dedicating equipment and staff to CRE patients
              • Removing gloves and gown and washing hands before leaving the room of a CRE patient
              • Only prescribing antibiotics when necessary
              • Removing temporary medical devices as soon as possible
              • Sometimes, hospitals will test patients for these bacteria to identify them early to help prevent them from being passed on to other patients
              • Communicate a patient's precaution needs with an interfacility transfer form when transferring a patient to another facility

              What can patients do to prevent CRE infections?

              Patients should:

              • Tell your doctor if you have been hospitalized in another facility or country.
              • Take antibiotics only as prescribed.
              • Tell your doctor about your CRE status
              • Expect all doctors, nurses, and other healthcare providers to wash their hands with soap and water or use an alcohol-based hand rub before and after touching your body or tubes going into your body. If they do not, ask them to do so.
              • Clean your own hands often, especially:
                • Before preparing or eating food
                • Before and after changing wound dressings or bandages
                • After using the bathroom
                • After blowing your nose, coughing, or sneezing
                • Ask questions. Understand what is being done to you, the risks and benefits.

              For more information go to the CDC CRE webpage at:

              CDC CRE Toolkit

              Carbapenem-resistant Enterobacteriaceae (CRE) are a serious threat to public health. Infections with CRE are difficult, and in some cases impossible, to treat and have been associated with mortality rates up to 50%(1). Due to the movement of patients throughout the healthcare system, if CRE are a problem in one facility, then typically they are a problem in other facilities in the region as well. To help protect patients and prevent transmission, CDC has updated 2012 CRE toolkit; this document will continue to be updated as new information becomes available.

              • CRE Toolkit

              CRE Patient Card

              pocket-sized informational card for handing out to patients (click the link below to download and print)