Carbapenem-Resistant Enterobacterales (CRE)

CRE Investigation Guidance

Organisms, Causative Agent, or Etiologic Agent

Carbapenem-Resistant Enterobacterales (CRE)

CRE, which stands for Carbapenem-resistant Enterobacterales, are a part (or subgroup) of Enterobacterales that are difficult to treat because they are resistant to commonly used antibiotics. Occasionally CRE are completely resistant to all available antibiotics. CRE are an important threat to public health.

Enterobacterales are a family of bacteria that include Klebsiella species and Escherichia coli (E.coli), which are found in normal human intestines (gut). Sometimes these bacteria can spread outside the gut and cause serious infections, such as pneumonia, bloodstream infections, urinary tract infections, wound infections, and meningitis. Enterobacterales are one of the most common causes of bacterial infections in both healthcare and community settings. Carbapenem are a type of antibiotic frequently used to treat severe infections.


To get a CRE infection, a person must be exposed to CRE bacteria. CRE bacteria are most often spread person-to-person in healthcare settings through contact with infected or colonized people, particularly contact with wounds or stool. CRE can cause infections when they enter the body, often through medical devices like intravenous catheters, urinary catheters, or through wounds caused by injury or surgery.


Enterobacterales cause many types of infections, such as pneumonia, urinary tract infections, and bloodstream infections. Infections caused by CRE are harder to treat because the bacteria are very resistant to antibiotics.


To prevent the spread of CRE, healthcare personnel and facilities can follow infection control precautions provided by CDC. These include:

  • Washing hands with soap and water or an alcohol-based hand sanitizer before and after caring for a patient
  • Carefully cleaning and disinfecting rooms and medical equipment
  • Wearing gloves and a gown before entering the room of a CRE patient
  • Keeping patients with CRE infections in a single room or sharing a room with someone else who has a CRE infection
  • Whenever possible, dedicating equipment and staff to CRE patients
  • Removing gloves and gown and washing hands before leaving the room of a CRE patient
  • Only prescribing antibiotics when necessary
  • Removing temporary medical devices as soon as possible

Sometimes, hospitals will test patients for these bacteria to identify them early to help prevent them from being passed on to other patients.

As a patient you should:

  • Tell your doctor if you have been hospitalized in another facility or country
  • Take antibiotics only as prescribed
  • Expect all doctors, nurses, and other healthcare providers to wash their hands with soap and water or an alcohol-based hand rub before and after touching your body or tubes going into your body. If they do not, ask them to do so.
  • Clean your hands often, especially:
    • before preparing or eating food
    • before and after changing wound dressings or bandages
    • after using the bathroom
    • after blowing your nose, coughing, or sneezing
  • Ask questions. Understand what is being done to you, the risks and benefits.

School Exclusion

CRE infections are rare in children. Unless directed by a physician, students with any type of CRE wound infection need to be excluded from attending school until drainage from wound or skin and soft tissue infection is contained and maintained in a clean, dry bandage. Restrict a child from activity that could result in the infected area being touched by others or becoming exposed, wet, soiled, or otherwise compromised.

Texas Trends

Carbapenem-resistant Enterobacterales has been found in Texas.

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