Is it possible to prevent a CRE infection?
Currently, outbreaks of CRE bacteria are small, but it may not remain that way. The CDC and other researchers know that many strains of Enterobacteriaceae can be deadly and difficult to treat even without being resistant to most antibiotics (for example, E. coli 0157:H7). How much damage could E. coli do to humans if it became a CRE bacterium by genetic transfer and retained its current pathogenic characteristics? Researchers and the CDC do not want to see this happen.
With additional pathogenic traits (easy person-to-person transfer, the ability to synthesize toxins such as enterotoxins) added to the ability to be resistant to most, if not all, antibiotics, the bacteria could devastate large populations of people. Since there are very few drug companies developing new antibiotics, the survival advantage may tip in favor of the bacterial pathogens, not to the infected people being treated with antibiotics.
Because recent CRE outbreaks have been small and often confined to hospital intensive-care units, nursing homes, and other treatment areas where the use of new and powerful antibiotics is most frequent, the CDC has developed an attack method to keep CRE and other similar bacteria away from the general population and to reduce the “dangerous” bacteria’s chances for survival and passage from these areas. The detailed method is described in the reference below and all health care workers are urged to participate to prevent widespread outbreaks of CRE and similar bacteria. An abbreviated version of the CDC recommendations is as follows:
Summary of Prevention (of CRE Infections) Strategies for Acute and Long-Term Care Facilities (CDC 2015)
Core Measures for All Acute and Long-Term Care Facilities
1. Hand hygiene
- Promote hand hygiene
- Monitor hand hygiene adherence and provide feedback
- Ensure access to hand hygiene stations
2. Contact precautions
- Place CRE colonized or infected patients on Contact Precautions (CP)
- Preemptive CP might be used for patients transferred from high-risk settings
- Educate health care personnel about CP
- Monitor CP adherence and provide feedback
- No recommendation can be made for discontinuation of CP
- Develop lab protocols for notifying clinicians and IP (inpatients or hospitalized patients) about potential CRE
- Place CRE colonized or infected residents that are high-risk for transmission on CP (as described in text); for patients at lower risk for transmission use Standard precautions for most situations
3. Patient and staff cohorting (grouping [keeping infected patients and caretakers separate from uninfected individuals])
- When available, group (cohort) CRE colonized or infected people and the staff that care for them even if patients are housed in single rooms
- If the number of single patient rooms is limited, reserve these rooms for patients with highest risk for transmission (for example, incontinence)
4. Minimize use of invasive devices
5. Promote antimicrobial stewardship
6. Screening (screening for CRE bacterial strains in patients and in high acuity areas, for example, intensive care units and isolation rooms used for patients with infections)
The CDC further recommends that patients identified with CRE infections should be bathed with 2% chlorhexidine and that areas that house or treat CRE-infected patients undergo strict decontamination treatments. Instruments that may be in contact with, or used to, diagnose, or treat CRE-infected patients should also undergo rigorous decontamination. The instruments used at UCLA were decontaminated, but now the hospital has instituted even more stringent decontamination protocols.
What is the prognosis of CRE infections?
In general, the prognosis of CRE infections ranges from fair to poor. If the infection is diagnosed early and appropriately treated, the prognosis may be fair, but if the CRE bacteria reach the bloodstream, death occurs in 40%-50% of infected patients.
Humans have many dangerous microbial enemies; researchers and health care professionals think CRE bacteria could be the first wave of many others. The CDC is giving guidance to health care workers about how to possibly reduce or prevent a large-scale outbreak of CRE bacteria.
In an effort to determine who may have been exposed to CRE bacteria, UCLA has offered free home-testing kits that can be analyzed at the hospital.