CRE (carbapenem-resistant Enterobacteriaceae) infections come from bacteria that are normally found in a healthy person’s digestive tract. When a person is receiving serious medical care (for example, involving urinary catheters, intravenous catheters, or surgery) these bacteria can end up where they don’t belong—for example in the bladder or blood. Because these bacteria have become resistant to antibiotics, these infections are very difficult to treat.
Recent outbreaks of CRE linked to contaminated duodenoscopes have been reported in U.S. healthcare facilities. The following resources may assist healthcare facilities in preventing infections associated with duodenoscopes.
The following links are APIC resources on CRE for healthcare professionals.
- Vital Signs: Protect Patients from Antibiotic Resistance, March 2016—Centers for Disease Control and Prevention
- CDC's Antibiotic Resistance Patient Safety Atlas—Centers for Disease Control and Prevention
- Interim Duodenoscope Surveillance Protocol—Centers for Disease Control and Prevention
- Interim Duodenoscope Sampling Method—Centers for Disease Control and Prevention
- Interim Duodenoscope Culture Method—Centers for Disease Control and Prevention
- Stop Infections from Lethal CRE Germs Now (Vital Signs report)—Centers for Disease Control and Prevention
- Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE)—Centers for Disease Control and Prevention
- Tracking CRE—Centers for Disease Control and Prevention
- Management of multidrug-resistant organisms in healthcare settings—Centers for Disease Control and Prevention
- Laboratory protocol for detection of carbapenem-resistant or carbapenemase-producing Klebsiella spp. and E. coli from rectal swabs—Centers for Disease Control and Prevention
- FDA releases final guidance on reprocessing of reusable medical devices—The U.S. Food and Drug Administration, issued 3/12/2015
- Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling—The U.S. Food and Drug Administration, issued 3/12/2015
- Design of Endoscopic Retrograde Cholangiopancreatography (ERCP) Duodenoscopes May Impede Effective Cleaning: FDA Safety Communication—The U.S. Food and Drug Administration, issued 2/19/2015
- Olympus validates new reprocessing instructions for model TJF-Q180V duodenoscopes—The U.S. Food and Drug Administration, issued 3/26/15
- Carbapenem-resistant Enterobacteriaceae (CRE) control and prevention toolkit—Agency for Healthcare Research and Quality
- ERCP scopes: What can we do to prevent infections?—Infection Control and Hospital Epidemiology, June 2015 (William A. Rutala and David J. Weber)
- ECRI Institute recommends culturing duodenoscopes as a key step to reducing CRE infections—ECRI Institute, March 3, 2015
- How to stop duodenoscope infections—American Gastroenterological Association, March 23, 2015
- Superbug reveals challenges with high level disinfection—The Joint Commission Quick Safety advisory, March 2015
- Multisociety guideline on reprocessing flexible gastrointestinal endoscopes, 2011—American Society for Gastrointestinal Endoscopy
APIC CRE reporting map
- Summary of state CRE reporting requirements—APIC Government Affairs resource
APIC communications resources
- Key talking points for infection preventionists to ensure effective reprocessing of ERCP duodenoscopes to reduce the risk of infection;
- The APIC and Society for Healthcare Epidemiology of America (SHEA) press release; and
- ERCP procedures and duodenoscopes frequently asked questions for consumers.
Education & training
APIC offers a comprehensive collection of clinical education and professional development programs. The following resources are educational opportunities related to CRE. Visit the Education & Certification page for more educational opportunities.
- Carbapenem-resistant Enterobacteriaceae (CRE)—APIC Webinar
- Comprehensive HAI Prevention: Finding and Controlling the Sources of Resistant Bacterial Transmission in the Healthcare Setting—APIC Webinar
- Read an abstract, presented at the 2013 Annual Conference, that analyzed 275 flexible duodenoscopes, gastroscopes, and colonoscopes.
- Visit the APIC 2014 Annual Conference website to order and access Conference Proceedings:
- The Central Role of IPs in Creating Realtime Responses in a Multi-year National Intervention to Control Carbapenem-Resistant Enterobacteriaceae in Israel
- Carbapenem-Resistant Enterobacteriaceae in Long-Term Care: How to Effectively Operationalize Transmission-Based Precautions
- Use of a Multidisciplinary Team and the Centers for Disease Control and Prevention’s Recommendations to Reverse an Outbreak of Carbapenem-Resistant Enterobacteriaceae in a Large Acute Care Hospital
- Visit the APIC 2016 Annual Conference website to search for education on CRE
- Access the APIC 2015 Conference Proceedings for sessions on CRE
- Learn how the infection prevention and control team successfully contained the NDM-1 CRE outbreak at University of Colorado Hospital.
- APIC Text (subscription required)
Prevention Strategist articles
- Carbapenem-resistant Enterobacteriaceae: Deadly superbugs on the rise—Fall 2014
- CRE outbreak in Israel—Fall 2014
- My Bugaboo: Carbapenem-resistant Enterobacteriaceae—Summer 2013
The following links are APIC and external resources on CRE for consumers.
- CRE: The ‘nightmare bacteria’—Monthly alert for consumers
- CRE—Bugs & Outbreaks, Infection Prevention and You
- What is CRE?—Monthly alert for consumers
- Antibiotic use—Monthly alert for consumers
- Get smart about antibiotics... and antibiotic resistance!—Monthly alert for consumers
- Carbapenem-resistant Enterobacteriaceae (CRE) Infection: Patient FAQs—Centers for Disease Control and Prevention
- Superbug poses danger in hospitals—CBS, 7/25/2013
- Antibiotic / Antimicrobial Resistance—Centers for Disease Control and Prevention