A new study from the Centers for Disease Control and Prevention (CDC) found that a surprising proportion of cases of carbapenem-resistant Enterobacterales (CRE) are found in isolates from patients in the community (CA-CRE). They had previously been thought to be healthcare-associated infections (HCA-CRE). Traditionally, CRE has been thought of as a nosocomial infection, acquired in a hospital or other healthcare facility (nursing home, long-term acute care hospital, dialysis center). This is the first population-level study to show otherwise, with fully 10% of the CRE isolates found to be community-acquired.

CREs are a group of multidrug-resistant bacteria considered an urgent health threat by the CDC because they can rapidly spread between patients, especially those who are most seriously ill and vulnerable, and because they are so difficult to treat. These patients often require treatment with new antibiotics, such as colistin, and carry a high mortality rate — up to 50% in some studies.

Overall, 30% of CREs carry a carbapenemase — an enzyme that can make them resistant to carbapenem antibiotics. The genes for this are readily transferable between bacteria and help account for their spread in hospitals.

In this study, published in the  American Journal of Infection Control , of the 12 isolates that underwent whole-genome sequencing, 42% of the CA-CRE isolates carried the carbapenemase gene. Lead author Sandra Bulens commented “The findings highlight the potential for CP-CRE to move from healthcare settings into the community. The fact that 5 of the 12 isolates harbored a carbapenemase gene introduces new challenges for controlling spread of CP-CRE.”1

You can read the full text here.

References

  1. Bulens, S. N., Reses, H. E., Ansari, U. A., Grass, J. E., Carmon, C., Albrecht, V., Lawsin, A., McAllister, G., Daniels, J., Lee, Y. K., Yi, S., See, I., Jacob, J. T., Bower, C. W., Wilson, L., Vaeth, E., Lynfield, R., Vagnone, P. S., Shaw, K. M., . . . Walters, M. S. (2022, July). Carbapenem-Resistant enterobacterales in individuals with and without health care risk factors —Emerging infections program, United States, 2012-2015. American Journal of Infection Control. https://doi.org/10.1016/j.ajic.2022.04.003

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