CRE (Carbapenem Resistant Enterobacteriaceae)
Medically reviewed by Drugs.com. Last updated on Apr 6, 2025.
What are carbapenem-resistant Enterobacteriaceae (CRE)?
CRE are a group of bacteria that are very difficult to kill when they cause infection. Examples include E. coli and klebsiella. CRE often cause lung, urinary tract, wound, and blood infections. Carbapenems are a group of antibiotics that treat bacterial infections. In CRE infections, the bacteria release chemicals that prevent carbapenems from killing them. This is called antibiotic resistance. CRE infections can become difficult to cure and can spread to other parts of the body. CRE infections that get into the blood can be life-threatening.
What is the difference between CRE colonization and CRE infection?
CRE colonization means that CRE can be found in the body, but are not causing infection. CRE infection happens when CRE travel to parts of the body that do not normally have bacteria there. These areas include the bladder, lungs, and blood.
Who is at risk for CRE infection?
Most people usually do not get an infection after exposure to CRE. You may be at higher risk for CRE infection if you have any of the following:
- A weak immune system
- Being treated for an illness in an acute or long-term hospital
- Recent treatment with certain antibiotics
- Recent medical treatment in another country with a high risk of CRE infection
- A recent procedure such as an endoscopic retrograde cholangiopancreatography (ERCP)
How are CRE spread?
CRE can spread from person to person through contact with an infected person's wound, bowel movements, urine, or sputum. CRE can be spread if a person touches an object that has CRE and touches another person. Stethoscopes, blood pressure cuffs, and thermometers can spread CRE from one patient to another if they are not cleaned correctly. CRE can get into the body through medical devices such as a ventilator (breathing machine), urinary catheter, or IV catheter. Poor handwashing is a major reason for the spread of CRE.
What are the signs and symptoms of CRE infection?
The signs and symptoms of CRE infection depend on which body part is infected. You may have any of the following:
- Fever and chills
- Little or no energy
- Loss of appetite
- Nausea and vomiting
- Cough or difficulty breathing
- Painful or difficult urination
- A rash or red, swollen skin with pus
How are CRE colonization and infection diagnosed?
You may need separate tests to check for colonization and infection:
- CRE colonization can be diagnosed through a rectal or perirectal swab. A sample may be taken from the area outside of your rectum, or inside your rectum. A sample of your bowel movement may also be tested for CRE.
- CRE infection can be diagnosed through blood and urine tests, or from abscess or infected tissue cultures. Fluid may be drained from an abdominal abscess and sent to the lab to be tested for CRE infection. If CRE infection is found, it will be tested in the lab for its reaction to antibiotic medicine. This will help your healthcare provider decide what antibiotics will kill the bacteria in your body.
How is CRE treated?
You will not need treatment if you have CRE in your body but are not infected. If CRE is causing an infection, you may need any of the following:
- Antibiotics are used to treat the infection. Several kinds of antibiotics may need to be tried. You may be given 2 or more antibiotics at the same time. Your healthcare provider may ask if you received antibiotics within the past month. You may need different antibiotics to lower the risk for resistance.
- Surgery or other procedures may be needed to drain an abscess (collection of fluid) or remove infected tissue.
How can I help prevent the spread of CRE?
You may be moved to a private room if you are in a healthcare setting. Healthcare providers and visitors may wear gowns and gloves during your care. Everyone must wash their hands before and after they leave your room. You can help prevent the spread of CRE at home by doing the following:
- Wash your hands often. Wash your hands several times each day. Wash after you use the bathroom, change a child's diaper, and before you prepare or eat food. Use soap and water every time. Rub your soapy hands together, lacing your fingers. Wash the front and back of your hands, and in between your fingers. Use the fingers of one hand to scrub under the fingernails of the other hand. Wash for at least 20 seconds. Rinse with warm, running water for several seconds. Then dry your hands with a clean towel or paper towel. Use hand sanitizer that contains alcohol if soap and water are not available. Do not touch your eyes, nose, or mouth without washing your hands first.
- Clean surfaces. Clean doorknobs, tables, and toilets often. Ask your healthcare provider what kind of cleaner to use.
- Cover your mouth and nose when you cough or sneeze. Use tissues or a cloth. Throw away the tissue after you use it. Use the bend of your arm if you do not have a tissue.
- Tell your healthcare provider if you have been hospitalized in another hospital or country. This will let your provider know if you are at risk for CRE and help you get early treatment for infections.
- Take antibiotics as directed. Do not stop taking your antibiotic, even if you start to feel better. The infection may return if you do not take all of your antibiotic. Follow up with your healthcare provider as directed. Do not take antibiotics when you do not need them. Do not share antibiotics or take other people's antibiotic medicine. Overuse of antibiotics can kill the good bacteria in your body.
- Ask about vaccines you may need. Get a flu vaccine as soon as recommended each year, usually starting in September or October. Get a COVID-19 vaccine and recommended booster doses. Your healthcare provider can tell you if you also need other vaccines, and when to get them.
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When should I call my doctor?
- You have a fever or chills.
- You have a wound that is red, swollen, or draining pus.
- You have had contact with someone with a CRE infection.
- You have questions or concerns about your condition or care.
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