How to stem the tide of carbapenemase-producing enterobacteriaceae?: proactive versus reactive strategies

The spread of carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemase-producing Enterobacteriaceae in healthcare settings is an important medical problem and a major public health threat. Infections with CRE are associated with high rates of morbidity and mortality, and are spreading rapidly across the globe. The medical community can either observe the natural course of this epidemic or act proactively and take adequate preventive measures to contain the spread of these bacteria. The purpose of this review is to highlight the impact of these problematic pathogens and to examine infection control policies needed in order to limit their spread.

The incidence of CRE is on the rise in several parts of the world; however, data regarding proper infection control methods on this issue are scarce. Great variability exists in infection control measures taken to confront CRE in various settings. Recently, two sets of guidelines to control CRE have been issued, one by the US Centers for Disease Control and Prevention and the other by an expert group under the auspices of the European Society of Clinical Microbiology and Infectious Diseases. These guidelines have many similarities but also considerable differences.

Whereas clinical information regarding how to contain infections by CRE pathogens is still limited, it is obvious that it relies on a multifaceted approach and implementation of strict infection control measures. Since it has been observed that lack of adequate and timely reaction is common and associated with great morbidity and mortality, preparation plans should be evaluated and implemented locally, regionally, nationally and even on an international level.