Carbapenem-Resistant Enterobacteriaceae (CRE)

Carbapenem-Resistant Enterobacteriaceae (CRE) are untreatable or difficult to treat bacteria that are resistant to carbapenem antibiotics and nearly all available antibiotics. They can cause serious illness and death; bloodstream infections are fatal in 40% -50% of cases. CRE was designated by the CDC in 2013 as one of the three most urgent drug resistant threats in the United States. An estimated 9,000 CRE infections cause 600 deaths yearly in the U.S.

Risk factors for CRE colonization or infection include open wounds, presence of indwelling devices (such as endotracheal tubes, feeding tubes, and catheters), multiple medical problems, and high antimicrobial use.  CRE are easily spread between infected or colonized patients by health care workers and equipment, unless rigorous infection prevention precautions are taken. Cases and outbreaks of CRE have been increasingly recognized in recent years in Northern California, including Alameda County. In June 2017, the Alameda County Public Health Department (ACPHD) issued a Health Officer Order for reporting CRE and submitting CRE isolates to the Alameda County Public Health Laboratory.

• Health Officer Order for Reporting Carbapenem-Resistant Enterobacteriaceae (CRE) and submitting CRE isolate
• ACPHD CRE Recommendation for Long-Term Care Facilities
• ACPHD CRE Recommendations for Acute Care Facilities
• ACPHD Public Health Laboratory Specimen Submittal Instructions
• ACPHD Public Health Laboratory Requisition Form for Bacterial Isolates
• ACPHD Interfacility Infection Control Transfer Form
• Centers for Disease Control and Prevention (CDC) CRE Toolkit, November 2015
• Oregon Health Authority Guidance for Control of CRE, 2016
• CDPH CRE web page
• CDC CRE in Healthcare Settings web page