Patient education: Carbapenem-resistant enterobacterales (The Basics)

What are carbapenem-resistant enterobacterales? — Carbapenem-resistant enterobacterales ("CRE") are bacteria that can cause an infection that is hard to cure. Carbapenems are a group of antibiotics that are used to treat many kinds of infections. But some types of bacteria have learned to outsmart the antibiotics that doctors normally use to kill them. Doctors call this "resistance."

People carry all sorts of germs inside their body and on their skin. The body usually controls these germs, so they do no harm. Many types of bacteria that can become resistant to carbapenem are found in the intestines. They are also found on surfaces in living spaces, especially bathrooms.

Some people have CRE inside their bodies but do not get an infection. This is called being "colonized." A person can be colonized without realizing it. When you are colonized with CRE, you can spread it to others, but simple actions can help to prevent spread.

How do you catch CRE? — CRE are common in hospitals and nursing homes. In these places, CRE have been found on bed rails, telephones, and medical equipment.

CRE are spread through touch:

●Often, it is spread by the hands of a person (usually a doctor, nurse, or caregiver) who has touched someone or something with CRE.

●People can also catch CRE by touching a surface with the germ on it. In the hospital, this includes touching things like call lights, bed rails, IV poles, elevator buttons, and other objects.

●Poor handwashing makes it more likely that someone will spread an CRE.

●This kind of infection is not spread through coughing or sneezing.

How do I know if I have CRE? — If you need to stay in the hospital, your doctor or nurse might check to see if you are already "colonized" with CRE. This involves putting a swab in or around your rectum, then doing a test to look for the bacteria. They can also test a sample of your stool for CRE.

If you do have CRE in your body, your doctor or nurse can do things to help prevent spreading it to other people.

CRE can cause infections in the urinary tract (bladder or kidneys), lungs, belly, or bloodstream. It can also cause a skin or wound infection, or an infection where an IV tube enters the body. If your doctor suspects that you have a CRE infection, they will do tests. These might include:

●Urine or blood tests to check for CRE

●Tests to see if you have CRE in a wound

●An imaging test, such as a CT scan, which takes pictures of the inside of your body

Can an infection with CRE be treated? — Yes. Your doctor can give you special antibiotics to treat your infection. The antibiotics can be given as pills or through a thin tube that goes into a vein, called an "IV."

If you get medicines to take at home, follow the directions exactly. Take all of the pills you are given, even if you feel better before you finish them. If you do not take them all, the bacteria could get resistance to the medicine you are taking.

If you are colonized with CRE but don't have an infection, you probably will not need antibiotics.

How do health care workers try to prevent infections? — The most important thing health care workers can do is wash their hands often. This will help prevent the spread of CRE as well as other infections. Doctors and nurses will wash their hands before and after they touch you. If there isn't a sink available, they might use an alcohol-based hand sanitizer instead.

Other things the staff might do to prevent the spread of infections include:

●Wearing gowns and gloves when they take care of you

●Placing patients in a separate room or in a room with other patients with the same kind of infection

●Cleaning medical equipment and hospital surfaces with special soaps

●Only using antibiotics when necessary. Overusing antibiotics can cause some germs to become resistant to that type of medicine.

●Teaching patients and visitors about infections and how to prevent them

What can I do to keep an infection from spreading? — If you have a CRE infection or are colonized with CRE, you can help keep the germs from spreading to others.

You should:

●Wash your hands often with soap and water. Scrub your hands for at least 20 seconds and rinse well. Clean your hands after using the toilet and before you eat.

●Take your antibiotics as instructed. Finish all of them, even if you are feeling better. This helps keep bacteria from becoming resistant to the medicine.

●Keep any cuts, scrapes, or wounds clean and covered until they heal.

●Tell your other doctors, nurses, or caregivers that you have had a CRE infection. They might want to take special precautions to prevent it from spreading.

If you are in the hospital or a nursing home:

●Make sure that your doctors and nurses wash their hands before they touch you. If there is no sink, they can use an alcohol-based hand sanitizer instead.

●Ask that stethoscopes and other tools be cleaned with alcohol before they touch you.

●Stay in your room. Do not go to visitor areas like the hallway or cafeteria. You might need to wear a special hospital gown if you need to leave your room.

●Family and friends who come to visit should wash their hands before and after they come in your room. They might also have to wear a special hospital gown while visiting.

At home:

●Family, friends, and caregivers might want to wash their hands after touching you. Washing hands is especially important after touching a wound, using the bathroom or helping a person use the bathroom, and cleaning the toilet or cleaning up a bowel movement. They should also wear gloves and wash their hands before and after touching your medical devices (for example, if you have a urinary catheter).

●Change your bedding at least once a week. If it is soiled, wear disposable gloves and change it more often. Try not to touch your clothing when handling the bedding. Wash and dry the bedding in hot water with liquid bleach or laundry soap with bleach in it. If your washing machine reaches temperatures over 130°F or your dryer reaches temperatures over 160°F, you do not need to use bleach. Do not wash or dry with other laundry.

●Clean frequently touched areas such as tabletops, sinks, toilets, bathrooms, and bedside commodes. Wipe with a bleach-based cleaner or make your own by mixing bleach solution using 1/4 cup bleach (60 mL) to 4 cups water (960 mL). Let the bleach solution sit for a few minutes before wiping it off.

●Avoid sharing personal items like towels, razors, or sports equipment.

More on this topic

Patient education: What you should know about antibiotics (The Basics)
Patient education: Hospital-acquired pneumonia (The Basics)
Patient education: Urinary tract infections in adults (The Basics)
Patient education: Central line infections (The Basics)
Patient education: How to wash your hands (The Basics)

Patient education: Urinary tract infections in adolescents and adults (Beyond the Basics)