The July 24, 2013, issue of the popular science magazine Nature includes a replete article about CRE – or, carbapenem-resistant Enterobacteriaceae.

Read Dr. Muscarella’s related post: “Growing National Concerns about Carbapenem-Resistant Enterobacteriaceae, or CRE.”

Written by Maryn McKenna, this Nature article discusses the history of this “nightmare,” or “superbug,” bacteria, from their first identification almost 15 years ago. It also traces CREs’ voyages from North Carolina and New York to Israel, New Dehli and Sweden.

Click here to read the related editorial — “The Antibiotic Alarm” — in the March 12, 2013, issue of Nature.

CREs do not only cause infections in intestine-care units. Some strains, namely, are gut-dwelling bacteria that have been linked to infections following “ERCP,” a type of gastrointestinal (upper) endoscopic procedure.

Click here to read Dr. Muscarella’s blog about the impact of CREs on gastrointestinal (GI) endoscopy: “Investigation and Prevention of Bacterial Outbreaks during Endoscopic Retrograde Cholangiopancreatography (ERCP).”

These resistant strains of K. pneumoniae bacteria produce an enzyme, called “KPC” (i.e., Klebsiella pneumoniae carbapenemase), that break down carbapenems — the antibiotics of “last resort” — providing these bacteria with their namesake for having rendered these drugs inert.

These bacteria are named “CRE” because of their resistance to the carbapenem antibiotics.

And, according to an article in USA Today (November 29, 2012), thousands of cases of CREs have been identified throughout the U.S. in recent years.

Click here to read Dr. Muscarella’s blog about the impact of CREs on gastrointestinal (GI) endoscopy: “Administration of Antibiotics Prior to Surgery: Is a “Timeout” Needed?”

Nature quotes Thomas Frieden, the director of the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, to say: “We have a very serious problem, and we need to sound an alarm” about CREs, which kill up to half of all patients who contract them.

Methods to prevent transmission of CREs in the healthcare setting include Contact Precautions. Click here to read Dr. Muscarella’s blog about these (and other types of) precautions.

This article in Nature also quotes Eli Perencevich, an infectious-diseases physician and epidemiologist at the University of Iowa in Iowa City, to say:

We haven’t invested in research in how to optimize even standard infection-control practices. We just blame the health-care workers when they go wrong.

This article in Nature is well presented and, along with the aforementioned USA Today article, is a “recommended” read. So, too, is the CDC article “Carbapenem-resistant Enterobacteriaceae (CRE) Infection: Clinician FAQs,” which can be read by clicking here.

Click here to read a program that provides external audits to optimize the quality of infection control in healthcare facilities.

Also read the CDC’s report (September, 2013) entitled: “Antibiotic Resistance Threats in the United States, 2013” — click here.

Blog written by Lawrence F Muscarella, PhD; posted: 8-21-2013. Email him with your questions: Larry@LFM-HCS.com

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