From the Guidelines
Chronic illnesses significantly increase the risk of Carbapenem-Resistant Enterobacteriaceae (CRE) infections through several mechanisms, including weakened immune systems, frequent healthcare interventions, and disrupted gut flora. Patients with chronic conditions, such as diabetes, cancer, kidney disease, and liver cirrhosis, are more susceptible to opportunistic infections like CRE due to impaired normal immune responses 1.
Key Factors Contributing to Increased Risk
- Weakened immune systems in patients with chronic conditions
- Frequent healthcare interventions, including hospitalizations, invasive procedures, and indwelling medical devices
- Disrupted gut flora due to multiple courses of antibiotics
- Extended duration of hospital stays, increasing exposure to healthcare environments where CRE may be present
- Malnutrition, poor wound healing, and altered physiological barriers, compromising the body's natural defenses against bacterial invasion
Recommendations for Management
- Use of novel β-lactam agents, such as ceftazidime/avibactam and meropenem/vaborbactam, as first-line treatment options for KPC-producing CRE infections 1
- Consideration of imipenem/relebactam and cefiderocol as potential alternatives for the treatment of infections involving KPC-producing CRE
- Optimization of antibiotic dosing schemes, with attention to adverse effects, especially with the old antibiotics—polymyxins and aminoglycosides 1
- Prioritization of source control to optimize outcomes and shorten antibiotic treatment durations 1
Conclusion Not Applicable, as per Guidelines
Instead, the focus is on providing evidence-based recommendations for the management of CRE infections in patients with chronic illnesses, prioritizing morbidity, mortality, and quality of life as outcomes.
From the Research
Chronic Illnesses and CRE Infections
- Chronic illnesses can increase the risk of Carbapenem-Resistant Enterobacteriaceae (CRE) infections due to various factors, including compromised immune systems and frequent exposure to healthcare settings 2, 3.
- Patients with chronic illnesses, such as those requiring long-term mechanical ventilation or with a history of surgery, are more likely to be colonized with CRE and develop invasive infections 2.
- Underlying conditions, such as necrotizing enterocolitis and/or short-bowel syndrome, can also increase the risk of colistin resistance in patients with CRE infections 3.
Risk Factors for CRE Infections
- Prior exposure to polyantibiotic therapy for Gram-negative bacteria is a significant predictor of CRE infections 3.
- The length of hospital stay prior to positive culture and history of surgery during admission are also predictors of CRE infections 3.
- Mechanical ventilation prior to index culture is a predictor of colistin resistance in patients with CRE infections 3.
Prevention and Control of CRE Infections
- Active surveillance of CRE colonization is essential to control the spread of CRE infections 2.
- Early detection of CRE colonization through screening testing can help prevent the spread of CRE infections 2.
- Effective implementation of preventive measures, such as proper infection control practices and antimicrobial stewardship, is crucial to reducing the risk of CRE infections 2.