Have you heard of our latest threat? Thereís MRSA, VRE, C.diff, EBSL and now -- CRE. Wait. What is CRE?
CRE stands for Carbapenem-Resistant Enterobacteriaceae, and itís the latest healthcare-acquired infection sweeping through medical centers, including oncology units. I heard about it recently, and went straight to the Center for Disease Control's (CDC) website to find out more.
According to the CDC patient information section, these infections are fatal in half of the cases noted thus far. Of course, it's most often seen in sick patients -- and donít we all know we see some of the sickest of the sick. The most susceptible cancer patients out there to any infection seem to be those with leukemia; these patients stay the longest in the inpatient setting, which is worrisome with existing diseases such as CRE.
This terrifies me as a nurse. To my knowledge, we havenít had any cases of this at my hospital.
This new bacterial, drug-resistant infection is known to be more drug resistant than many, if not all, of the other known multi-drug resistant organisms. The potentially fatal condition is known to be tied to the use of carbapenems, cephalosporins, fluoroquinolones, and vancomycin. Our oncology unit administers many of these drugs to help treat and prevent infection. Unfortunately, many of the drugs used to prevent opportunistic infections in the cancer patient may allow for the development of CRE infections.
How is it spread? CRE is spread through contact -- commonly via an infected personís stool, urinary catheters, central catheters, and/or open wounds.
The symptoms of CRE will depend on where the infection enters the body. For example, if the bacteria enters via the lungs, then the patient will display symptoms of pneumonia, but the culprit of the infection will be CRE.
So, what does this new infection mean for us? If a patient is known or suspected of being infected, we need to immediately place them on contact precautions. We also need to be vigilant about hand hygiene (as we should be anyway).
Although there is no direct antibiotic treatment available for patients with CRE, some patients may receive treatment with other antibiotic drugs such as aminoglycosides, polymyxins, and temocillin, but administration of these antibiotics at high doses may in turn produce high toxic levels.
According to the CDC, unlike C.diff., we can use either alcohol-based hand sanitizers, or soap and water. We should also keep catheters out of patients who donít need them. Urinary catheters are one of the largest known mediums of infection with CRE.
We need to change dressings appropriately -- if soiled, change it. We should also be implementing chlorhexadine bathing on high-risk patients. (This is something my facility actually does on ALL patients admitted as a means of decreasing bloodstream infections.)
What has been your experience with cancer patients who have contracted an infection with CRE?