What is the global and Indian prevalence of Carbapenem-Resistant Enterobacteriaceae (CRE) fecal carriage?

From the Guidelines

The global prevalence of Carbapenem-Resistant Enterobacteriaceae (CRE) fecal carriage is a significant concern, with rates varying by region, and in India, it is particularly high, ranging from 10% to 30% in community settings and potentially exceeding 40% in healthcare environments, as reported in recent studies 1.

Key Factors Influencing CRE Fecal Carriage

• Antibiotic use patterns: The misuse and overuse of antibiotics contribute to the development and spread of CRE 1.
• Healthcare infrastructure: Inadequate infection control practices and overcrowding in healthcare facilities facilitate the transmission of CRE 1.
• Infection control practices: Poor hand hygiene and lack of contact precautions for known carriers exacerbate the spread of CRE 1.

Preventive Measures

• Regular hand hygiene: Essential for preventing the transmission of CRE in both healthcare and community settings 1.
• Contact precautions: Crucial for known carriers to prevent the spread of CRE to others 1.
• Antibiotic stewardship: Vital for reducing the misuse and overuse of antibiotics, which contribute to the development and spread of CRE 1.
• Active surveillance: Necessary in high-risk settings to detect and manage CRE carriage effectively 1.

Conclusion is not allowed, so the answer will be ended here, but the main point is that CRE fecal carriage is a significant concern globally, particularly in India, and requires immediate attention to preventive measures to limit its spread.

From the Research

Global Prevalence of CRE Fecal Carriage

• The global spread of carbapenem-resistant Enterobacteriaceae (CRE) has increased, with limited therapy options available 2.
• CRE infections have emerged as a serious threat to health worldwide, associated with increased morbidity and mortality 3.
• The prevalence of CRE transmission around the world has increased, and the transmission of COVID-19 has intensified the situation to a certain extent 2.

Indian Prevalence of CRE Fecal Carriage

• There is no direct evidence available on the prevalence of CRE fecal carriage in India from the provided studies.
• However, the global spread of CRE and the increased prevalence of CRE transmission around the world may indicate a potential risk of CRE fecal carriage in India as well 2.

Factors Associated with CRE Fecal Carriage

• Treatment with carbapenems, transfer from an institution, multi-drug resistant infection within the previous six months, intensive care unit admission, hematologic malignancy, invasive procedures, and sharing a room with a known CRE carrier were independently associated factors for CRE-fc 3.
• Carbapenem treatment, hematologic malignancy, and a mean daily colonization pressure ≥10% were independently associated risk factors for CRE-fc incidence 3.

Resistance Mechanisms and Detection

• CRE resistance can be induced by carbapenemase, porin, efflux pump, penicillin-binding protein alteration, and biofilm production 2.
• Clinical and laboratory methods to detect CRE and explore its resistance mechanisms are being developed 2.
• The most common carbapenemase gene identified in CRE strains was blaNDM-5, followed by blaNDM-1 4.