Carbapenem-resistant enterobacteriaceae (CRE)

Enterobacteriaceae is a family of bacteria (germs) that normally live in the bowel. E. coli is a well-known type of enterobacteriaceae.

Carbapenem antibiotics are generally used to treat these types of bacterial infections. However, carabapenem-resistant bacteria (CRE) have become resistant to carbapenem antibiotics and have to be treated with different antibiotics.

CRE infections are rare in Australia but are more difficult to treat. Patients often pick up the bacteria when they’ve received medical care overseas, particularly in Greece, India and South‑East Asia.

Healthy people do not usually get CRE infections. However, people may carry CRE in their bowel or in a wound without symptoms. This is called colonisation.

People who are colonised with CRE are at risk of getting a CRE infection if they have an operation or other hospital treatment.

Who is at an increased risk of getting a CRE infection?

Children in hospital who have:

• other health conditions that make them sick
• been in a hospital or care facility before
• been frequently treated with antibiotics
• weakened immune systems such as intensive care patients, or those in cancer or transplant wards
• recently travelled to countries where resistant bacteria are more common
• spent a large amount of time in hospitals overseas, particularly in Asia.

Diagnosis

CRE is diagnosed by testing wound swabs or urine, faeces, blood, sputum or tissue samples.

Treatment

Most CRE infections can be treated with certain antibiotics. Laboratory tests can determine which antibiotics will work.

If your child is colonised with CRE but it’s not making them sick, then no treatment is needed. However, if you know your child is colonised with CRE, it’s important to tell healthcare workers if they are going to be receive medical treatment and/or be admitted to hospital.

Some children can be cleared of CRE. This depends on the use of antibiotics, if they have any drains/tubes or devices and if they have any ongoing health conditions.

How is CRE spread?

CRE can be passed directly onto others via the hands of healthcare workers, visitors, carers, children or indirectly on equipment such as bed and cot rails, medical equipment, door handles and bathroom fixtures.

Preventing the spread of CRE

Good hand hygiene is the best protection against CRE. This means using an alcohol-based hand rub or washing with soap/antiseptic and water to clean your hands regularly. Everyone who cares for or visits your child must follow these precautions at all times to reduce the risk of spreading of this germ.

When should you clean your hands?

Always clean your hands:

• before handling anything that goes in the mouth
• before preparing or eating food or drinks
• after going to the toilet or changing nappies
• after using a tissue or handkerchief
• after handling rubbish
• after handling dirty washing
• after coming into contact with an affected area (avoid touching wherever possible)
• before leaving a patient’s room.

Infection precautions during a hospital admission or visit

If your child is in hospital with a CRE infection, there will be special precautions in place to minimise risk of spreading the virus to other patients.

Your child may stay in a single room or share a room with a child with the same germ. Your child will be asked to stay in their room, unless they are receiving tests and treatment.

Healthcare staff will use personal protective equipment (PPE) such as gloves, gowns and masks when caring for your child.

Your child may also have visitor restrictions – check with your child’s care team.

If your child attends the hospital as an outpatient, precautions will remain in place to protect other children who are at high risk of infection. These may include using a single room or booking your appointment at a time when there are fewer patients. Please tell staff before your visit that CRE precautions are required.

Developed by the Infection Management and Prevention Service, Queensland Children’s Hospital.

Resource ID: FS220. Reviewed: January 2024.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.