US CDC guidance for control of carbapenem-resistant Enterobacteriaceae (CRE) – 2012 CRE toolkitArchived

Carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemase-producing Enterobacteriaceae (CPE) are highly resistant to antibiotics, leaving only a few options for treatment of infected patients, and thus represent a serious threat to public health. Due to the movement of patients throughout the healthcare system, if CRE/CPE are a problem in one hospital/facility, then they typically become a problem in other hospitals/facilities in the same region. To help protect patients and prevent transmission of CRE/CPE, the US Centers for Disease Control and Prevention (CDC) released a toolkit which expands on the 2009 CDC recommendations and will be updated as new information becomes available.

The 2012 CRE toolkit is made of two parts:

• Part 1 corresponds to hospital/healthcare facility-level CRE prevention. It contains recommendations for healthcare facilities and is intended to expand upon the March 2009 “Guidance for control of carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute-care facilities.” An appendix specifically provides an approach for CRE control in facilities that rarely or have not yet identified CRE.
• Part 2 corresponds to regional CRE prevention and reviews the role of public health authorities in the control of CRE. It provides specific guidance for regions, depending on their level of CRE in healthcare: no CRE identified, few CRE identified and CRE common.

For further information: 2012 CRE Toolkit - Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE)

ECDC comment (25 June 2012)

The CDC guidance for control of carbapenem-resistant Enterobacteriaceae (CRE) is an important milestone and provides a comprehensive approach for strengthening public health preparedness for CRE prevention and control at both hospital/healthcare facility- and regional levels. The optimal response against CRE must be adapted to the prevalence of CRE within a given geographical area and the CDC guidance provides recommendations tailored to the different levels of CRE in healthcare facilities and at regional level. 

Carbapenemases have emerged and spread among the Enterobacteriaceae family of bacteria worldwide. Although the exact prevalence of CPE in healthcare facilities and within the community in Europe is unknown, publications from Member States, expert groups and surveillance systems, including the European Antimicrobial Resistance Surveillance Network (EARS-Net), indicate that CPE are endemic in certain countries are regularly responsible for hospital outbreaks in several European countries. Risk factors for CPE include severity of illness, a history of hospitalisation or a stay in an intensive care unit, prior antimicrobial use and immunosuppression.

Patient mobility has also recently been highlighted as a risk factor for the acquisition of CPE in many reports from Member States discussing the introduction and spread of CPE into healthcare settings as a result of patient transfer, mostly from endemic areas, across borders.

In 2011, ECDC published two risk assessments reviewing the situation related to CPE in Europe:

• The updated ECDC risk assessment on the spread of New Delhi metallo-β-lactamase and its variants within Europe (1) , November 2011.
• The ECDC risk assessment on the spread of carbapenemase-producing Enterobacteriaceae through patient transfer between healthcare facilities, with special emphasis on cross-border transfer (2), September 2011.

The aim of these risk assessments was to evaluate the risk to the citizens of Europe of CPE spread through patient mobility and to assess the effectiveness of infection control methods to stop the spread of CPE within healthcare institutions. The assessment stressed the need to intensify public health preparedness for the surveillance and containment of CPE in Europe.