Technical Information CRE | CREATE | THERE IS (2023)

For public health, laboratories, health centers and doctors.

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Types of CRE

  • How does the CDC define CRE?
  • How does Enterobacterales become resistant to carbapenems?
  • What is the difference between CRE and CP-CRE?
  • How common are carbapenemases?
  • How common are metallobetalactamase genes such as NDM and VIM in CRE in the United States?

Identification of CRE and carbapenemases

  • Why is the carbapenemase test important?
  • How can a laboratory determine if a CRE is a producer of carbapenemases?

CRE Epidemiology and Prevention

  • How are CREs transmitted?
  • Which patients are most at risk of acquiring CRE?
  • What infections cause CREs?
  • What is the difference between colonization and infection by CRE?
  • What are the recommendations to prevent the spread of CP-CRE?
  • What are the recommendations for preventing the spread of CREs that do not produce carbapenemases?


CDC recommendations for
Management of Multidrug-Resistant Organisms in Healthcare (2006)

Carbapenem-resistant Enterobacteriaceae (CRE) are multidrug-resistant organisms that can cause serious infections and require public health interventions to prevent spread. Aimed at medical, laboratory, and public health professionals, the following information provides answers to frequently asked questions about CRE, including types of CRE, identification and epidemiology, and prevention strategies.

Types of CRE

How does the CDC define CRE?

Enterobacteriaceae that are resistant to at least one of the carbapenem antibiotics (ertapenem, meropenem, doripenem, or imipenem) or produce a carbapenemase (an enzyme that can make them resistant to carbapenem antibiotics) are referred to as CREs.

Einige Enterobacteriaceae (z. B.Proteus spp., Morganella spp., Providencia spp..) have intrinsically high Minimum Inhibitory Concentrations (MICs) for imipenem and therefore the results for meropenem, doripenem and ertapenem for these organisms should be used to determine whether these organisms meet the CLP definition.

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How does Enterobacterales become resistant to carbapenems?

Many different mechanisms can lead to carbapenem resistance in Enterobacterales.

Carbapenemase-producing CREs produce enzymes called carbapenemases that inactivate carbapenems and other beta-lactam antibiotics, including penicillins and cephalosporins. The presence of a carbapenemase is usually sufficient to induce resistance to carbapenems. Many carbapenemase genes are located on mobile genetic elements that can be passed from one bacterium to another, spreading resistance. A carbapenemase thatKlebsiella pneumoniaeCarbapenemase (KPC), was first identified in 2001 in the United States. Since then, KPC-producing bacteria have spread across the country. In addition to KPC, there are several other carbapenemases associated with mobile genetic elements, including

  • Neu-Delhi Metallo-Beta-Lactamase (NDM)
  • Verona Integrron-Encoded Metallo-Beta-Lactamase (VIM)
  • Imipenemasa (IMP)
  • Oxacilinasa-48 (OXA-48)

Although non-KPC carbapenemases have historically been linked to health exposures outside of the United States, they have been identified in many states across the country and in patients who have not received medical care abroad.

Learn more about CRE monitoring
CRE tracking

CRE can also become resistant to carbapenems through a combination of chromosomal mutations and acquired mechanisms of non-carbapenemase (eg, lactamase) resistance. CREs lacking carbapenemase are referred to as non-carbapenemase producing CREs.

Some enterobacteria, such asmorganella morganii,Schutztypes andprovidencespecies, always have high minimum inhibitory concentrations (MIC) for carbapenem, but imipenem has also been found to contain carbapenemase genes.

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What is the difference between CRE and CP-CRE?

CREs are enteric bacteria resistant to carbapenem antibiotics. This is a phenotypic definition (ie based on the organism's antibiotic susceptibility pattern). There are many different mechanisms (ie genotypes) that can lead to carbapenem resistance. CREs that produce carbapenemases, enzymes that break down carbapenems and related antimicrobial agents and render them ineffective, are called carbapenemase-producing CREs (CP-CREs). CP-CREs ​​are therefore a subset of all CREs.

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How common are carbapenemases?

In the United States, CREs are commonly associated with healthcare settings, and approximately 30% of CREs contain a carbapenemase. These carbapenemase genes are often located on mobile genetic elements that are easily shared between bacteria, leading to the rapid spread of resistance.

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How common are metallobetalactamase genes such as NDM and VIM in CRE in the United States?

NDM, VIM, and IMP are identified less frequently in CRE than in KPC in the US. Since the AR Lab Network began testing in 2017, only about 10% of identified carbapenemases have been metallo-β-lactamases (MBLs). Preventing the spread of these carbapenemases is critical because they are resistant to some newer antibiotics that are effective against KPC-producing CRE.

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The 2018 Sanford Guidelines for Antimicrobial Therapy recommend ceftazidime-avibactam + aztreonam combination therapy for the treatment of severe infections caused by MBL-producing CRE. Talk to your HAI coordinator about testing MBL-producing CRE isolates against this combination therapy via the AR Lab Network.

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Identification of CRE and carbapenemases

Why is the carbapenemase test important?

Testing for the carbapenemase mechanism is important for the prevention of CRE because it identifies CP-CREs ​​for which a public health response is recommended and allows healthcare facilities and public health departments to better target various interventions to patients. different types of CRE. For more information on specific CRE measures for healthcare facilities, seeCDC CRE Toolkit PDF-Symbol [PDF – 1 Seite].

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How can a laboratory determine if a CRE is a producer of carbapenemases?

Clinical laboratories can perform phenotypic assays for carbapenemase production (eg, CarbaNP, mCIM, and mCIM with eCIM) or molecular assays for the presence of a carbapenemase gene (CLSI, M100, S29).

Carbapenemase testing is available through the AR Lab Network. This assay includes phenotypic testing for carbapenemase activity and molecular identification of the five carbapenemases most commonly identified in CRE: KPC, NDM, VIM, OXA-48 type, and IMP.

Note that carbapenem susceptibility results must be reported as established along with the appropriate interpretation. Results from tests that detect carbapenemase production should not be used to alter the interpretation of a carbapenemase susceptibility result. The result of a carbapenemase test should be reported to infection control, a case report should be sent to the National Disease Notifiable Surveillance System (NNDSS), and those requesting or requesting epidemiological information should be notified (e.g., state or local public health agencies). of the program). ).

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CRE Epidemiology and Prevention

How are CREs transmitted?

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In healthcare, CREs are transmitted from person to person, often through the hands of healthcare workers or through contaminated medical equipment. Additionally, sink and toilet drains are increasingly recognized as an environmental reservoir and source of CRE transmission. Preventing the transmission of CRE requires careful hand hygiene, the appropriate use of transmission-based precautions (i.e. the use of contact precautions or enhanced barrier measures, depending on the environment and organism), protection of the environment through cleanliness, and compliance with Hygiene Practices for Sinks and Toilets.

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Which patients are most at risk of acquiring CRE?

The major risk factors for acquiring CRE in the United States include exposure to medical care and exposure to antibiotics. Risk factors associated with health care include the need for assistance with most activities of daily living, such as walking. B. toileting and bathing, exposure to an intensive care unit, and mechanical ventilation. Several antibiotics have been associated with the occurrence of CRE, including carbapenems, cephalosporins, fluoroquinolones, and vancomycin.

Exposure to antibiotics can change the community of bacteria that live in a person's body (microbiome). This might make it easier for someone without a CRE to acquire. For patients with CRE that colonize their digestive tract, taking antibiotics can increase the amount of CRE in the body and the chance of developing an infection or spreading CRE to other patients. Several antibiotics have been associated with the occurrence of CRE, including carbapenems, cephalosporins, fluoroquinolones, and vancomycin.

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What infections cause CREs?

CRE can cause infections in almost any part of the body, including urinary tract infections, bloodstream infections, ventilator-associated pneumonia, and intra-abdominal abscesses.

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What is the difference between colonization and infection by CRE?

Infection occurs when a pathogen such as CRE invades a site in the body and causes signs and symptoms of disease. Colonization means that the organism is in or on the body but does not cause any symptoms or disease. People colonized with CRE can develop CRE infections and transmit CRE to other patients; Therefore, SRC prevention practices include colonized and infected individuals.

Free colonization detection
AR Lab Network Tests pdf icon[PDF – 1 page]

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CRE most commonly colonizes the digestive tract. Screening of specific individuals at high risk for CRE colonization is a CDC-recommended intervention that may help prevent the spread of CRE-CP. These high-risk individuals include patients or residents who share some of the same risk factors as a newly identified CP-CRE-colonized individual (eg, hospitalized in the same unit) and patients who have been hospitalized outside of the United States in the past became 6 months. . . AR Lab Network offers free colonization testing.

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What are the recommendations to prevent the spread of CP-CRE?

Most of the increase in carbapenem resistance in Enterobacterales in the United States and worldwide has been attributed to the spread of carbapenemase genes. These genes can be transferred between bacteria, increasing the spread of carbapenem resistance. Therefore, CP-CREs ​​are the target of intensive prevention efforts. The CDC recommends a coordinated public health response to identify even single cases of unusual carbapenemase, with an assessment of infection control practices and an assessment of possible transmission through colonization screening.

Guide for CRE inspection bodies
CRE Toolkit pdf icon [PDF - 1 page]

Because CP-CREs ​​are transmitted by contact, careful adherence to basic infection control practices prevents human-to-human transmission. This includes:

  • Use of contact precautions for CRE-infected or colonized individuals in the ICU
  • Improved barrier measures for CRE-infected or colonized individuals in post-acute care
  • Compliance with hand hygiene and environmentally friendly cleaning and disinfection

For more information on installation-level prevention strategies, see the CRE Toolkit and Facility Information on CRE.

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What are the recommendations for preventing the spread of CREs that do not produce carbapenemases?

CREs that do not produce carbapenemases generally remain resistant to multiple antibiotics (i.e., multidrug-resistant organisms) and likely justify the use of specific infection control measures (e.g., contact precautions in intensive care units) in healthcare settings to limit transmission. More aggressive interventions, such as B. colonization screening in contacts, but are generally reserved for CP-CRE, which have a greater potential for spread.

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What does CRE stand for? ›

What are CRE? CRE stands for carbapenem-resistant Enterobacterales. Enterobacterales are an order of bacteria commonly found in people's gastrointestinal tract that can cause infections both in healthcare and community settings.

What is considered CRE? ›

When Enterobacterales develop resistance to the group of antibiotics called carbapenems, the germs are called carbapenem-resistant Enterobacterales (CRE). CRE are difficult to treat because they do not respond to commonly used antibiotics. Occasionally CRE are resistant to all available antibiotics.

What is the difference between CRE and CPE? ›

While there is certainly a significant overlap between CRE and CPE, it is important to distinguish them since the former refers to the resistance phenotype, whereas the latter is defined by the mechanism underlying the phenotype.

What does CRE mean in engineering? ›

A Certified Reliability Engineer is a professional who understands the principles of performance evaluation and prediction to improve product/systems safety, reliability and maintainability.

What does CRE stand for in engineering? ›

Contracts Engineering Manager (CEM) Contract Responsible Engineer (CRE) Jobs. The Contracts Engineering Manager (CEM) Contract Responsible Engineer (CRE) is an integral component in helping to deliver a successful construction project.

What does CRE mean in banking? ›

Commercial real estate (CRE) loans include loans secured by liens on condominiums, leaseholds, cooperatives, forest tracts, land sales contracts, construction project loans, and—in the states that consider them real property—oil and mineral rights.

What is the other term for CRE? ›

Carbapenem-resistant Enterobacteriaceae (CRE) and other Carbapenem-Resistant Organisms. Cause: Carbapenem-resistant Enterobacterales (CRE) and other carbapenem-resistant organisms (CRO) are a significant public health concern and contribute to the growing problem of antibiotic resistance.

What is a CRE sample? ›

CRE stands for carbapenem-resistant Enterobacterales. Enterobacterales are an order of germs, specifically bacteria. Many different types of Enterobacterales can develop resistance, including Klebsiella pneumoniae and Escherichia coli (E. coli).

What is one of the major process of CRE? ›

Continuous Rotary Extrusion (CRE) process is also known in literature under Conform TM name and it is mainly used for the continuous extrusion of Aluminum and Copper alloys. CRE use a feedstock in the form of rod, powders and chips, which is fed into the groove of the rotating wheel.

What does CRE mean in sales? ›

Corporate real estate (CRE) is the real property that a company owns or holds for the purposes of housing its operations. Multiple types of properties and facilities, including offices, warehouses, data centers and retail spaces, can be part of a corporate real estate portfolio.

What is CRE strategy? ›

A CRE Strategic Plan includes goals and implementation plans for: Improving alignment with corporate goals and objectives. Reducing overall cost of ownership and operations. Establishing a consistent model for delivery of services globally. Documenting operating standards and governance processes.

Is CRE a contact precaution? ›

CRE colonization does NOT require antibiotic therapy, but CRE- colonized patients can still spread infection. Both CRE-colonized and CRE-infected patients should be isolated using contact precautions when they are admitted to hospital.

What is CRE screening? ›

If a doctor suspects that a person has a CRE infection, they will take a sample of their bodily fluid, such as blood or urine, to test in a laboratory. The laboratory test will confirm the species of bacteria and determine if the bacteria are resistant to antibiotics.

Is CRE contact isolation? ›

CPE are isolated predominantly from patients and residents with exposures in health care facilities and can spread from person to person by the hands of health care workers when hand hygiene is missed, or via shared medical equipment that is not properly cleaned and disinfected.

What does CEM stand for engineering? ›

Construction engineering management (CEM) is a sub-discipline of civil engineering that focuses on the execution of engineering and architectural design projects.

What is CRE in risk management? ›

Credit Risk Management for Commercial Real Estate (CRE) Lenders. The Moody's Analytics CRE suite provides a comprehensive way to measure and manage CRE exposure risk.

What is a CRE financial analyst? ›

Credit Analyst

Performs cash flow and financial analysis for CRE and C&I loans. Critically assessing rent rolls, financial statements, tax returns, management profiles and account relationships to evaluate potential…

What does CRE mean in nursing? ›

Skilled Nursing Facilities

CRE, which stands for Carbapenem-resistant Enterobacteriaceae, are a family of bacteria that include Klebsiella species and Escherichia coli. CRE are difficult to treat because they have high levels of resistance to antibiotics. CRE are an important emerging threat to public health.

What is CRE reporting? ›

Carbapenem-Resistant Enterobacterales (CRE)

Antibiotic Resistant/Multidrug Resistant Organisms (AR/MDROs) Report a suspected or confirmed case within 1 work day to your local health department.

How do you prepare CRE? ›

Before beginning your exam preparations, you need have a comprehensive understanding of the exam specifics, hence the official guide is a requirement.
  1. Reliability Fundamentals.
  2. Risk Management.
  3. Probability and Statistics for Reliability.
  4. Reliability Planning, Testing, and Modeling.
  5. Life-Cycle Reliability.

How do you evaluate CRE? ›

The simple steps are:
  1. Calculate the Net Operating Income.
  2. Determine the appropriate Capitalization Rate.
  3. Divide the Net Operating Income by the Cap Rate to arrive at an estimated value.

What is CRE in job description? ›

CRE- Customer Relationship Executive.

What is a CRE professional? ›

Those designated a “Counselor of Real Estate” are prominent real estate practitioners recognized for their expertise, experience, and ethics in providing advice that influences real estate decisions.

What is CRE in corporate? ›

Capital Redemption Reserve (CRR) is a requirement under the Companies Act which applies to buy-back schemes and redemptions of preference capital. The requirement should be followed by companies which are redeeming preference capital through any of the three specified modes.

What does a CRE analyst do? ›

Market Data & Analysis: Find and analyze market data that is relevant to the project they are evaluating. For example, analysts may look at market rental rates, absorption figures, and vacancy. Sensitivity Analysis: Analysts may run many different scenarios to account for unforeseen circumstances.

How hard is CRE exam? ›

CRE exam is a 4.5 hours CBT (computer based testing) or pen-paper based exam. It has some educational and work experience pre-requisites. By far it is one of the toughest exams of ASQ and has lowest pass rates. In the website you will also find the recommended list of books and training.

What are CRE operations? ›

GCS CRE Services provide an integrated platform designed to improve operational efficiency. They ensure operations and facilities long-term structural costs are minimized; capital expenditures are reduced or eliminated; and short-term operating decisions are scalable within a comprehensive strategic plan.


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