Rapid risk assessment: Carbapenem-resistant Enterobacteriaceae, 14 April 2016

Risk assessment
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European Centre for Disease Prevention and Control. Rapid risk assessment: Carbapenem-resistant Enterobacteriaceae – 8 April 2016. Stockholm: ECDC; 2016.

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​Carbapenem-resistant Enterobacteriaceae (CRE) pose a significant threat to patients and healthcare systems in all EU/EEA Member States. CRE infections are associated with high mortality, primarily due to delays in treatment and the limited availability of effective treatment options. New antibiotics which could replace carbapenems are not in sight.

This rapid risk assessment provides several options to reduce the risk of CRE, e.g. treatment options, transmission prevention and measures related to the healthcare system. 

Executive summary

The rapid spread of carbapenem-resistant Enterobacteriaceae (CRE) poses a significant threat to patients and healthcare systems in all EU/EEA Member States.

CRE infections are associated with high mortality, primarily due to delays in administration of effective treatment and the limited availability of effective treatment options. New antibiotics capable of replacing carbapenems, a last-line group of antibiotics used to treat patients infected with multidrug-resistant bacteria, are not likely to become available in the near future. Furthermore, CRE are adapted to spread in healthcare settings as well as in the community.

This ECDC risk assessment outlines the current and possible future risks for human health, the potential for spread both in healthcare settings and in the community, and cross-border aspects that must be taken into consideration both in EU/EEA Member States and in third countries. Options for action addressing these areas are presented in the risk assessment.

Options to prevent transmission of CRE in hospitals and other healthcare settings include: timely and appropriate laboratory investigation to avoid delay in appropriate treatment, good standard infection control practices, screening of patients considered at high risk of digestive tract carriage of CRE, enhanced control measures in healthcare settings (contact precautions, patient isolation or cohorting, and dedicated nursing) for patients who are CRE-positive, and the development of antimicrobial stewardship programmes. 

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