“CRE: Nightmare Bacteria”

CRE, stands for carbapenem-resistant enterobacteriaceae that include the strains of E.coli and Klebsiella resistant to the 4th generation drug carbapenem. Carbapenem is a class of antibiotics usually prescribed as last option when other antibiotics failed to work. These organisms are described as “nightmare bacteria” because they have developed resistant against all type of antibiotics and are associated with high rates of mortality and morbidity making them potentially dreadful.

CRE infections on globe are on rise, especially among critically ill patients, patients hospitalized for prolong period, and other medical staff are exposed to invasive devices such as ventilators or central venous catheters. These bacteria are also characterized as multidrug resistant bacteria (MDRO). According to CDC reports, MDRO been growing at an alarming rate, it has grown from 1% to 8% in a time span of eight years.

Centers for Disease Control and Prevention (CDC), also reported that CRE have become resistant to 18 antibiotics, and is categorized as an “urgent” public-health threat globally.  CDC also reported, each year 9,300 health-care associated infections United States alone are caused by CRE. Unfortunately 50% of hospitalized patients that develop bloodstream infections from CRE and ultimately lead to their deaths.

Globally CRE infections are designated as a critical-priority pathogen by the World Health Organization, this mean they execute the greatest threat to human health and their spread is extremely hard for the healthcare centers to control.

CRE are basically “normal” bacteria that have evolved and mutated to acquire gene that enable them to produce enzymes effective against most antibiotics, making these powerful antibiotics inadequate against them. With the conjugation process, these “superbugs” share their genome with other bacteria, their antibiotic-resistant qualities help them spread more rapidly.

CRE infections not only pose threat to patients in hospitals, but also nursing homes, and other types of health-care facilities. John R. Palisano, a professor of biology at the University of the South in Sewanee, Tennessee stated: “Patients are exposed to carbapenem-resistant bacteria while they are on ventilators or after undergoing medical procedures involving catheters or endoscopes (a flexible tube that allows doctors to view the digestive tract), with medical instruments that were not properly cleaned and sterilized.”

The treatment for the CRE infections are extremely limited. There are only few antibodies recognized that can limit the infectious spread for brief time, otherwise mortality rate with CRE infection is enormously high.

The CRE can only be minimized by making cleanliness as integral part of healthcare set-ups.  Cleanliness can help prevent the bacterial transmission among health-care facility. The medical devices need to be methodically cleaned and sterilized before use. Moreover, once cleaned and sterilized, devices needed to be handled only by trained personnel and in order to keep the hygiene and cleanliness of workspace effective.

The use of antibiotics should also be limited and should only prescribed under conditions that warrant their use. The only way to avoid antibiotic resistance is to take medication according to physician’s instructions.

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