Carbapenem-Resistant Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae (CRE) are a family of gram-negative bacteria that are resistant to all known β-lactam antibiotics, including penicillins, cephalosporins, monobactams, and carbapenems. A recent study showed up to 50% mortality rate for patients who developed septicemia from an underlying CRE infection.1

In healthcare settings, CRE infections most commonly occur among patients who are receiving treatment for other conditions. Patients whose care requires devices such as ventilators (breathing machines), urinary (bladder) catheters, or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are at increased risk for such infections.

Carbapenem resistance in CREs is driven primarily by the enzymes known as β-lactamases that break down and inactivate β-lactam antibiotics. Bacteria are able to quickly share the genetic information for synthesis of these enzymes, resulting in rapid emergence of broad resistance. Today, the frequency of CRE bacteria is growing rapidly. A University of Pittsburgh study reported a 400% increase in CRE occurrence between 1999 and 2010.2

Due to the rapid dissemination of resistance and associated high mortality rates, the Center for Disease Control and Prevention (CDC) has classified CRE as Hazard Level – Urgent.3


1 Borer, A., Lisa Saidel-Odes, M. D., Riesenberg, K., et al. Attributable Mortality Rate for Carbapenem-resistant Klebsiella Pneumoniae Bacteremia. In Infection Control and Hospital Epidemiology, 2009, 30:972-6. CDC.
2 CDC Morbidity and Mortality Weekly Reports 130308 (v26n9)
3 ANTIBIOTIC RESISTANCE THREATS in the United States, 2013