CRE Bacteria Infection (Carbapenem-Resistant Enterobacteriaceae)

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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What causes CRE infections? How is CRE transmitted?

This resistance to carbapenem is not the only reason CRE bacteria are considered dangerous. CRE bacteria that reach the bloodstream have a mortality (death) rate of 40%-50%. CRE are transmitted person to person, usually by direct contact with contaminated feces, skin, or instruments used in hospitals.

How do CRE bacteria develop?

The genetics of Enterobacteriaceae are complex; many genera and strains possess genetic material that codes for resistance against many types of antibiotics; unfortunately, as a strain develops resistance to an antibiotic, not only does it become resistant to that antibiotic, the genes that confer resistance to one antibiotic become linked to each other. Consequently, as different antibiotic resistance occurs, the genetic material can become linked together thus conferring antibiotic resistance to several antibiotics in a single bacterial strain. Such bacteria that are resistant to several antibiotics are considerably more dangerous to humans they may infect than are bacteria susceptible to antibiotics.

As new antibiotics are introduced, they can pressure the bacteria to adapt to survive even the newest and most powerful ones; bacteria survive by allowing to replicate those few bacteria that develop stable resistance components that are genetically coded and then pass on genetic antibiotic resistance to other bacteria. Unfortunately, this new genetic ability is then again linked to other antibiotic-resistant genetic material, thus resulting in "dangerous" bacterial strains that are resistant to many, if not all, antibiotics. That is the current situation for CRE bacteria. Keep in mind that there are strains of CRE bacteria that can fairly easily transfer genetic information to other bacterial strains that do not have multiple drug resistance but may have the potential to be dangerous under certain circumstances (for example, enterotoxigenic E. coli).

Medically Reviewed by a Doctor on 2/24/2015

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