"Overview of Carbapenem-Resistant Enterobacteriaceae"

Abstract

CRE are bacteria that are difficult to treat because they have high levels of antibiotic resistance. Infections are associated with a mortality of 40-50%. Sites of CRE colonisation include the lower gastrointestinal tract, the oropharynx and skin. One must expect that a person who picks up CRE will remain at risk of infection themselves and be a source of risk to others indefinitely. There is insufficient evidence on decolonisation regimens so this is not recommended. Two studies have found that around 9% of those with CRE rectal carriage progress to infection [1]. Admission to an Intensive Care Unit, having a central venous catheter, exposure to antibiotics and diabetes increase the risk of colonisation turning into infection. CRE has spread significantly in recent years with 19 Irish hospitals reporting 89 CRE cases between 2011 and early 2014 (2). One HSE region has seen a greater increase in colonisations than others. This may be due to the following: * A real increase in CRE in this region greater than other regions. * An increase in screening relative to other regions leading to increased detection of colonisations. * Differential reporting from other regions to the National Reference Laboratory, Galway. We have designed a review of our local region. Key questions fit into the following three categories: 1. Characteristics of patients colonised with CRE 2. Routine screening 3. Outbreak management Additionally, we have examined the national screening guidelines and their impact in this setting.