CDC: Time to Sound An Alarm about CRE

Carbapenem-resistant Enterobacteriaceae (CRE), known in the media as the 'nightmare' infection, has been seen increasingly since first diagnosed in the United States in 2001. A group of infections in the Enterobacteriaceae family, the interesting and lethal difference these germs share is the ability to produce an enzyme that interferes with the antibiotics of last resort, carbapenems.

"It’s not often that our scientists come to me to say that we have a very serious problem and we need to sound an alarm."

March 6, 2013, CDC Director Tom Frieden

CRE has a 50% mortality rate when it has created a bloodstream infection, and most often affects persons with compromised systems and using ventilators, intravenous catheters, urinary catheters, or through wounds caused by injury or through invasive surgery. Not only hospital patients, but persons in long-term care facilities are also infected most frequently.

CRE is not a particular germ. It is a group in the Enterobacteriaceae family, including Klebsiella pneumoniae and Escherechia coli (E. coli) that can produce a particular enzyme that makes the antibiotics in the carbapenem family, as well as several others, ineffective. Although the percentage of these strains that have the "KPC" enzyme (Klebsiella pneumoniae carbapenemase) is relatively low, under 5% in most cases, it is growing rapidly and spreading geographically. The results are so devastating and antibiotics so ineffective that the CDC has determined public awareness must be raised.

Results of the infection vary depending on the particular pathogen (or germ) responsible. Some of the infections potentially caused include pneumonia, bloodstream infections, urinary tract infections, wound infections, and meningitis. 

Until recently, Kansas, Nebraska and Oklahoma were three of eight states that had not detected significant instances of the enzyme that helps these unusual strains fight off antibiotics, according to a September 2012 report by CDC. Missouri reported significant cases.

Disinfecting and Cleaning

Hospitals and long-care facilities are not the only places CRE infections can be passed. As the percentage of resistant strains increases, the greater the threat will be in factories, offices and schools. Wounds in particular will become more dangerous to monitor for infection.

This changing threat level of bacteria that have been under the control of antibiotics for decades places a much higher value on cleaning and disinfection. Cleaning for health is more important not just in hospitals, but other care facilities, the workplace, and schools. 

Introductory special: $7.79/quart March 6 through April 30, 2013. Call 800-727-7876 to order. Mention "Internet Introductory Special."Outside the body, pathogens such as E. coli and Klebsiella pneumoniae are bacteria that can be killed by products listing them on their EPA-registered efficacy sheets. Modern products such as Critical Care, an Envirox product, are less-toxic to humans and much faster working than older disinfectant types. Critical Care is registered to kill E. coli with just 2 minutes of dwell time. That is one-fifth the time of older types of disinfectants. Yet it is not an eye or skin irritant, not a hazardous chemical, not a skin sensitizer, and not a DOT classified chemical. Critical Care is also registered against three specific bacteria types for 24-hour effectiveness after application. This around-the-clock effectiveness adds a new dimention to cleaning for health.

Introductory special: $14.33/quart through April 30, 2013. Call 800-727-7876 to order. Mention "Internet Introductory Special."Clorox Dispatch Hospital Cleaner is registered effective against Klebsiella pnemoniae as well as E. coli, and in just one minute. This dwell time is realistic in the modern cleaning world. 10-minute dwell times of older technologies use 10 times as much labor. They are not likely to take place with janitors tasked to do so much work during the cleaning day. Investments in technically saavy chemistry are returned many times over in productivity, safety and effectiveness.

Guide to control of CRE in medical settings