ICU/CCU team would like to present ;-

CARBAPENEM
RESISTANT
ENTEROBACTERIACEAE

WHAT IS C.R.E??

CRE are defined as Enterobacteriaceae

that nonsusceptible to one of the
Carbapenems

and

Doripenem

Meropenem

Imipenem

resistant to all 3rd generation of cephalosporin

Ceftriaxone
3rd generation
of cephalosporins??

Cefotaxime

Ceftazidime

WHAT IS enterobacteriaceae?
E.Coli

Enterobacter cloacae

Proteus mirabilis

Klebsiella spp.

Importance of carbapenems?
-lactamase enzyme

-lactam ring
Bac cell wall

Bacteria

Killed by antibiotic

Resistant
Give resistant to
other bac & cause
problems

Resistant bac grow &

take over

Examples of cre??
klebsiella pneumoniae
Carbapenemase (KPC)
New DelhiMetallo-betalactamase. (NDM)

Susceptible
enterobactericeae

CRE

Cre: another type of mdro

No decolonization strategy
Few treatment options available
High mortality rate
(50% or greater in some studies)
High speed/rate of
resistance transfer

Who might be atrisk of

carrying CRE?

Patient with prior history of

carriage or infection.

Patient who has been in close contact with a

patient diagnosed as being a carrier (e.g.
sharing room & toilet)
Patient admitted to a specialist care area:
critical care unit, haematology, oncology,
transplant ward
Patient transferred from another hospital in
acute hospital or long term care facility

How does a CRE patient

present?
carrier
Infected

How does CRE spread?

Place your
sign and
educate..

Nursing
Responsibilities

Hand
hygiene

Promote antibiotic
stewardship

Active surveillance

Isolation nursing
What are we
doing?

Terminal
cleaning

Cleaning

5 moments of hand hygiene

HANDS UP PLEASE..

Isolation & Cohorting

Place CRE patients

rooms
If not available,
cohort patients in the
same room

in

single-patient

Preference for single rooms given to

patients at highest transmission risk (stool
incontinent, medical devices, open
wounds)

Isolation & Cohorting

To the extent possible, cohort CRE patients to specific
areas and staff.
Cohort patients with
Please use
less
CRE infection or
medical de
colonization to specific vices and
remove it w
hen it is
units/wardsnor a
o longer n
ecessary
specific area within
the unit/ward
Dedicate staff to CRE patients or minimize the
number of staff caring for CRE patients

Promote Antimicrobial
Stewardship
Ensure antibiotics are used for appropriate
indications and duration
Follow local prescribing guidelines & use
the antibiotic care
right drug, right dose etc.
Use narrowest spectrum
appropriate antibiotics

Active surveillance
Active surveillance cultures
Culturing patients who meet certain criteria
(e.g., admitted from other hospitals, admitted
to ICU)
Communicate with your Infection Control Officer
as soon as CRE is identified
Lab calls with info, place patient in contact
precautions and call your Infection Control
Officer

CRE-Summary
CRE are a group of bacteria resistant to
antibiotics
Patients can be colonized or infected
Any patient with CRE can transmit the bacteria
To prevent transmission:
Strict Hand Hygiene
Contact Precautions for all health care
encounters
Work with Infection Control Services when have
a case

Questions &
Answers session
Raise up
your hand to
answer..

1. Name 3 examples of Carbapenems which

stated earlier on in CRE definition
CRE are defined as Enterobacteriaceae that
nonsusceptible to one of the
Carbapenems

xxxxxxxxx

xxxxxxxxx

xxxxxxxx

resistant to all 3rd generation of cephalosporin

2. What type of isolation precaution that has to

be taken for CRE cases?

A. Droplets precaution
B. Airborne precaution
C. Contact precaution

3. CRE can present in two ways. What are they?

Provide brief explanation.

5. State 5 nursing responsibilities when dealing

with CRE cases

Thank you
for lending
your ears