Posted by: Chris Maloney | March 6, 2013

Fear the Bacterial Tide: Forget MRSA, Fear CRE!

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None – This image is in the public domain and thus free of any copyright restrictions. As a matter of courtesy we request that the content provider be credited and notified in any public or private usage of this image. (Photo credit: Wikipedia)

Many people are now familiar with the term MRSA, which stands for Methicillin-resistant Staphylococcus aureus. If you aren’t familiar with this hospital bug that now has gone into our communities, have a look at the Mayo Clinic’s rundown (warning: icky pictures).

I’ve written previously about my fear of VRSA, which is when nothing works to kill that bacteria.  If you want more on that, here’s the blog post.

Now the CDC has posted a special notice about something I wasn’t previously scared of, but now am.  These are CRE, Carbapenem-Resistant Enterobacteriaceae.  If you haven’t heard of them, welcome to the club.  I knew that enterococcal species were becoming resistant, but I wasn’t aware of how fast the resistance was growing.  It’s gone from one to 4% in the past decade.  That doesn’t sound like much, but “18% of long-term acute care hospitals and about 4% of short-stay hospitals in the US had at least one CRE infection during the first half of 2012.”  What happens when you have CRE?  We don’t have any treatments.  “CRE kill up to half of patients who get bloodstream infections from them.”  (See the CDC CRE info here.)

How do we stop CRE?  Well, it’s an oral/fecal issue, folks.  That means washing your hands.  So we need to wash our hands between patients.  “Efforts should be made to promote staff ownership of hand hygiene using techniques like developing local (e.g., unit) hand hygiene champions. It is not enough to have policies that require hand hygiene; hand hygiene adherence should be monitored and adherence rates should be fed directly back to front line staff.” (quoted directly from the CDC toolkit for CRE).

What can you as a patient do?  Print out the following:


If you are ever in the hospital, have someone tape it to your forehead.  It saves you from the following conversation:

Sorry, the CDC says I have to make sure you wash your hands in front of me before you touch me, because you might have fecal material on your hands.

How effective will this be at preventing CRE?  Well, we’ve had lots of other reasons (MRSA, VRSA, etc.) to do so in the past, so unless they start handing out tasers to patients we aren’t going to see more hand washing generally.

Is there anything else we can do?

Yes, stay out of the hospital.  In a study of CRE sufferers who survived: “Mean time to CRE negativity was 387 days (95% confidence interval: 312-463). Seventy-eight percent of patients (64/82) had positive culture at 3 months, 65% (38/58) at 6 months, and 39% (12/30) at 1 year. Duration of carriage was affected by repeat hospitalization.”  So people do get better over time as their own bacteria overcome the CRE.  I looked for studies of probiotics and CRE, but medline only gives 321 studies on CRE at all.  So we’re talking a relatively poorly studied problem.



  1. […] Fear the Bacterial Tide: Forget MRSA, Fear CRE! […]

  2. […] Fear the Bacterial Tide: Forget MRSA, Fear CRE! ( […]

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