Enterobacterales are a group of bacteria (germs) that are a normal part of the human and animal gut but can also cause infections. Carbapenem- resistant Enterobacteriaceae (CRE) are germs resistant to one or several antibiotics called carbapenems.

CRE can include germs like Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) if they develop resistance to carbapenems.

Transmission
  • Person-to-person contact from dirty hands, wounds, or stool
  • Contaminated medical equipment and devices

A few reports described spread between animals and humans and animal-to-animal spread. In some cases, people or animals can carry the germs on or in their body without being infected, known as colonization.

Symptoms
  • Pneumonia
  • Bloodstream infections
  • Urinary tract infections
  • Wound infections
  • Meningitis
Treatment

CRE infections are difficult to treat. They are resistant to most antibiotics, including carbapenems, drugs often used to treat multidrug-resistant bacterial infections. Health care providers make treatment decisions for CRE infections on a case-by-case basis. If your provider prescribes antibiotics, take them exactly as instructed and finish the full course, even if you feel better.

Prevention
  • Take antibiotics exactly as your health care provider recommends
  • Follow patient safety tips that are given by your health care providers
  • Keep your hands clean

Information for Health Care Workers

General Health Care-Associated Infection Resources

According to a recent federal survey, one in 25 hospital patients have a health care-associated infection (HAI).

The Agency for Healthcare Research and Quality has shown that the implementation of recommendations from the Healthcare Infection Control Practices Advisory Committee can reduce HAI by 70% overall and virtually eliminate some specific types of infections.

Strategic Plan: Prevent HAI and Antimicrobial Resistance

Developed by the Florida Department of Health’s Health Care-Associated Infection Prevention Program.

View Strategic Plan
Multi-Drug Resistance Organisms (MDRO)

Patients can also take action to help protect themselves from these types of infections:

  • Speak up when receiving care and ask health care workers to wash their hands before touching you.
  • If you are having surgery ask your doctor what you can do before surgery to help prevent infection or if you have a catheter, ask each day if it is still needed.  
  • Only take antibiotics when you need them, finish the course of treatment (do not stop taking your medicine when you begin to feel better), and remember that antibiotics typically are not effective against the common cold.
Isolation and Hygiene Signage
Prevention Resources
Florida Health Care-Associated Infection Program Information

Broad implementation of the guidelines saves lives, reduces suffering, and decreases health care costs. Through partnerships and the commitment of stakeholders, the Florida Department of Health’s Health Care-Associated Infection Prevention Program supports health care facilities implementing best practices for preventing the spread of HAIs.

Health care facilities are asked to conduct surveillance or track HAI infections, ensure health care workers perform hand hygiene before and after patient contact and when they come in contact with body fluids, use personal protective equipment such as gowns and gloves, minimize use of devices (e.g. catheters), and ensure the patient care environment has been cleaned including the proper cleaning of shared medical equipment, such as blood pressure cuffs and glucometers.

In addition, antibiotics need to be used wisely. Antibiotics do help fight infection, however overuse of antibiotics leads to the development and spread of multi-drug resistant organisms. Health care providers are asked to order cultures and review the results to ensure the most narrow spectrum antibiotic is used to treat infections.

Infection Control Training

The Health Care-Associated Infections Prevention Program of the Florida Department of Health has five separate web-based training modules on infection control, specifically created for facility nursing staff members in acute care hospitals, ambulatory care, and nursing homes. These trainings are available on-demand and at no charge. Each will satisfy one hour of continuing education units.

The training modules are available on the TRAIN Florida. If you do not have an account, you can create an account. You will be directed to a page that will ask for your professional license. You will need to choose your license and enter your license number to receive continuing education credit.

You can find the courses by searching for “FDOH Infection Control” and filtering the affiliate with “Florida.”  You may select the class you want to take separately, or in a series by selecting the infection control series. With the series, you will take a brief Introduction course that will explain the course directions, the class “An Overview of Infection Control,” and select one course from the remaining classes dependent on your position and type of facility.

To register for the module

  • Select the Registration tab, and then select Launch. Once completed, you will mark the course as completed. You will see a message stating Course was marked as “Completed.”
  • You will need to take a 10-question quiz and post review.
  • You need to score 70% on the quiz to pass the course, and you will need to post a review to receive credit for the class.

Blended Learning Series (Compilation)

Introduction and Overview (both classes are required)

Elective Modules (only one course from this section is required)

Each of these courses can be taken separately