Infection Control Strategies for Carbapenem-Resistant Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae (CRE) present a persistent threat to global health owing to their capacity for rapid spread, high mortality rates and limited therapeutic options. Effective control demands a multifaceted approach integrating active surveillance, rapid diagnostics and strict adherence to infection-prevention measures. Screening of high-risk patients on admission enables early detection of colonised individuals, while contact precautions and dedicated cohorting of patients and staff limit cross-transmission. Environmental cleaning with sporicidal agents and optimisation of hand-hygiene practices underpin day-to-day containment. Antimicrobial stewardship complements these efforts by curbing unnecessary carbapenem use and preserving drug efficacy. Advances in real-time genomic surveillance have enhanced outbreak detection, allowing tailored interventions within interconnected healthcare networks. Emerging biologic strategies, including phage-based decolonisation and CRISPR-Cas antimicrobials, show promise for targeted reduction of intestinal carriage. Coordinated regional and national frameworks that integrate hospital, long-term care and community settings remain essential to interrupt transmission pathways and safeguard front-line antimicrobial resources.

Research from Nature Portfolio

Recent studies have demonstrated the feasibility of phage-delivered CRISPR-Cas systems to selectively eradication of gut-colonising CRE in preclinical models, paving the way for human trials of targeted decolonisation. Another advancement involves the deployment of portable nanopore sequencing in clinical wards, which enabled real-time mapping of transmission clusters and guided rapid cohorting decisions that curtailed outbreak duration. Further research has characterised novel carbapenemase variants and identified small-molecule inhibitors that potentiate existing disinfectants, suggesting new avenues for environmental decontamination and surface-based interventions.

Infection Control Strategies for Carbapenem-Resistant Enterobacteriaceae publication trend

The graph below shows the total number of articles in infection control strategies for carbapenem-resistant enterobacteriaceae across all publications each year (not limited to Nature Index journals).

Technical terms

Carbapenem-resistant Enterobacteriaceae (CRE): Gram-negative bacterial family resistant to carbapenem antibiotics, often via acquired carbapenemase enzymes.

Carbapenemase: Enzyme that hydrolyses carbapenem antibiotics, rendering them ineffective against the producing organism.

Active surveillance: Proactive screening strategy to detect colonised or infected patients early, typically through rectal swabs or stool cultures.

Cohorting: Grouping together patients infected or colonised with the same organism, with dedicated staff and resources to prevent cross-transmission.

Contact precautions: Infection-prevention measures including use of gowns, gloves and patient isolation to interrupt person-to-person spread.

References

1. Carbapenem-Resistant Klebsiella pneumoniae in Large Public Acute-Care Healthcare System, New York, New York, USA, 2016–2022 - Volume 29, Number 10—October 2023 - Emerging Infectious Diseases journal - CDC. Emerging Infectious Diseases (2023).
2. The contribution of community transmission to the burden of hospital-associated pathogens: A systematic scoping review of epidemiological models. One Health (2024).
3. Carbapenem-Resistant Enterobacterales in Long-Term Care Facilities: A Global and Narrative Review. Frontiers in Cellular and Infection Microbiology (2021).