CRE: The Deadly Bacteria Super Bug Nightmare!

Carbapenem-Resistant Enterobacteriaceae cre superbugWhat is CRE?

CRE stands for Carbapenem-Resistant Enterobacteriaceae, a group of bacteria called gram-negative bacteria that are resistance to the strongest antibiotic and thus very difficult and impossible to treat. Gram-negative bacteria has a unique membrane structure, with the strong outer membrane which protects the inner membrane or cell wall of the bacteria from antibiotics and dyes. Enterobacteriaceae, the common strains also known as  E. coli and Klebsiella pneumoniae live in the gut, but many times it can spread causing severe infections like sepsis, Urinary tract infection, pneumonia.  Carbapenem is considered a last resort antibiotics used to treat severe bacterial infections. According to Center for Disease Control, the reason that this bacteria is so deadly is that, the enterobacteriaceae now has a gene that produces an enzyme called  Klebsiella pneumoniae carbapenemase (KPC) which breaks down and inactivates Carbapenems, making them resistance to all the antibiotics. This is a bacteria that acts more like a virus. KPC is similar to New Delhi Metallo-beta-lactamase-1 (NDM-1) another enzyme that is resistant to bacteria but less common in the United States.

Who is at a risk of getting CRE?

Everybody is at risk of getting CRE, but people who have a healthy immune system recover from CRE. On the other hand people with compromised immune system, people who are hospitalized for a long period and have chronic illnesses, people on intravenous catheters, ventilators and antibiotics are not only at risk of getting CRE super bug but, the chances of these people surviving are 50%.

How does CRE spread?

CRE bug lives in the hospitals and is often spread by the people who work in the hospitals like doctors, nurses and other healthcare workers. This bacteria is thus spread by touch, or contaminated medical equipment. CRE cannot be spread by air. CDC has released CRE prevention tool kit for hospitals to prevent the spread of this disease. CDC has warned the alarming increase of this super bug  42 states in the United States has reported that at least one person is suffering from CRE in their hospitals.

What are the symptoms of Carbapenem-Resistant Enterobacteriacea (CRE)?

The symptoms of CRE infection depends on the type and the site of infection a person contracts. For example, if CRE enters the lung, the person will get pneumonia and the will have the symptoms of pneumonia  or if it enters the blood, it will cause the infection in the blood, in the urine it will cause the symptoms of Urinary Tract Infection. The only difference is that the bacteria is CRE and deadly for the person who is infected by it. Scary part of all of this is that, you might have CRE and not even know it.

How is CRE diagnosed?

Person is diagnosed by taking a culture sample usually stool sample, which is then tested for the resistance of the strain to determine if the person has Carbapenem-Resistant Enterobacteriaceae.

Are there any available treatments for CRE?

Aminoglycosides, polymyxins, tigecycline, fosfomycin, and temocillin are the antibiotics used to treat CRE infections.Studies suggest the combination of these antibiotics with carbapenem is a better option of treatment. However treatment with these antibiotics comes with risks as high doses have high toxic levels. Right now there is no available antibiotic drug for CRE and there is a very little chance that one will be produced in the near future. This is because the drug companies are not motivated to invest in the drug , as CRE can develop new resistance very fast to any new antibiotic so the effect of the new drug will not last for long.

In an article published in The New England Journal Of Medicine , doctors have made some recommendations like the infusion of monoclonal antibodies. Monoclonal antibodies are the antibodies that are similar to immune cells and they have the capacity to bind to a specific molecules or antigens, making it easier for white blood cells to identify and kill the bacteria more effectively without the use of antibiotics. Another suggestion made is the use of probiotic bacteria which would help fight the bad bacteria. Until we find a drug to fight CRE, prevention is the best way to keep CRE at bay. Antibiotics should be used sparingly by the doctors to prevent the formation of bacteria like CRE who are adapting due to this overuse of antibiotics. Remember hand washing is the best method that prevents any infection, whether it is viral or bacterial.

Sources:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6209a3.htm?s_cid=mm6209a3_w

http://www.cdc.gov/vitalsigns/HAI/CRE/

http://www.cdc.gov/hai/organisms/cre/cre-patientFAQ.html

http://jac.oxfordjournals.org/content/65/8/1807.short

http://www.nejm.org/doi/full/10.1056/NEJMra0904124

http://www.nejm.org/doi/full/10.1056/NEJMp1215093

http://www.fmshk.org/database/articles/03mb5_14.pdf

Image source: Creative Commons License Esther Simpson via Compfight

 

 

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