From the Guidelines
Decolonization for Carbapenem-Resistant Enterobacteriaceae (CRE) has limited effectiveness, so control practices focus primarily on preventing transmission, with the most recent and highest quality study recommending bundle interventions including contact isolation of CRGNB infected patients/carriers to prevent CRGNB infections 1. The cornerstone of CRE control includes strict contact precautions with patients in single rooms when possible, dedicated equipment, and enhanced environmental cleaning with hospital-grade disinfectants effective against gram-negative bacteria.
- Key components of CRE control include:
- Strict contact precautions
- Dedicated equipment
- Enhanced environmental cleaning
- Meticulous hand hygiene using alcohol-based hand sanitizers or soap and water before and after patient contact
- Active surveillance through rectal swabs or stool samples for high-risk patients
- Antimicrobial stewardship is crucial to reduce selective pressure for CRE development. While decolonization attempts have shown inconsistent results, some regimens have been tried, including oral gentamicin (80mg four times daily), oral colistin (1-2 million units four times daily), or combination therapy for 7-14 days, as reported in studies such as 1 and 1. However, these regimens often lead to temporary suppression rather than true decolonization, with high recolonization rates after treatment cessation, as noted in studies like 1. This is because CRE can persist in the gastrointestinal tract where antibiotics may not achieve sufficient concentrations, and the dense microbial environment facilitates horizontal gene transfer of resistance mechanisms. Recent guidelines, such as those from 1, emphasize the importance of bundle interventions, including contact isolation, in preventing the spread of CRGNB infections, highlighting the need for a multifaceted approach to CRE control.
From the Research
Decolonization Practices for CRE Control
- Decolonization practices are crucial in reducing the spread of Carbapenem-Resistant Enterobacteriaceae (CRE) [(2,3)]
- Active surveillance cultures can help identify patients with CRE colonization, allowing for early intervention and prevention of transmission [(4,5)]
- Gastrointestinal screening may permit early identification of patients with CRE infections, enabling targeted decolonization strategies 3
Control Practices for CRE Control
- Hand hygiene (HH) is an effective intervention to reduce the spread of CRE, with improved compliance resulting in significant reductions in HA-CRE colonization rates 2
- Contact precautions, active surveillance cultures, monitoring, audit and feedback of measures, patient isolation or cohorting, and environmental cleaning are all important components of a multimodal approach to CRE control 4
- Institution of contact isolation precautions for patients with CRE colonization can help decrease CRE colonization and infection rates 5
Infection Control Precautions
- Basic infection control precautions, such as hand hygiene and contact precautions, are essential in reducing the impact of CRE on vulnerable patients 3
- Active surveillance with a high rate of compliance to basic infection control precautions seems to be the best approach to reduce the impact of CRE on vulnerable patients 3
- Environmental cleaning and disinfection are also critical in preventing the spread of CRE 4