Carbapenem-resistant Enterobacteriaceae (CRE) case: Acute care hospital; Reno, Nevada in August 2016
A 70-year-old female patient suffered a broken leg during a trip to India and struggled with a repeated hip infection that led to multiple hospitalizations in that country, most recently in June 2016. After her return to the US, a wound culture revealed Klebsiella pneumoniae. Antimicrobial susceptibility testing demonstrated resistance to 26 antibiotics, including all aminoglycosides and polymyxins tested. The K. pneumoniae isolate also showed intermediate resistance to tigecycline, which is a tetracycline derivative developed in response to emerging antibiotic resistance. The mechanism of resistance was ultimately confirmed by the CDC as New Delhi metallo-beta-lactamase (NDM). The patient developed septic shock and died in September 2016.
The overuse of antibiotics is leading to more and more antibiotic resistant bacteria. The CDC considers CRE to be an urgent antimicrobial resistance threat. These organisms have demonstrated rapid geographical spread and, because Enterobacteriaceae are a common cause of community-acquired infections, can quickly become an issue across entire communities. For this reason, even though CRE is not a nationally reportable condition, several states have added (or are considering adding) CRE to the state’s reportable conditions list.
Steps to control the transmission of CRE will require a coordinated effort among all healthcare team members. It is necessary to recognize the epidemiological importance of CRE and determine the impact the organisms will have, both in specific facilities and regionally. When CRE is present in healthcare facilities, colonized and infected patients must be identified and interventions implemented to stop their spread.