Carbapenem-resistant Enterobacterales infection

Enterobacterales include bacteria that normally inhabit the human and animal gut but may also cause infection. CRE can include carbapenem-resistant Escherichia coli and Klebsiella pneumoniae; the term describes an antimicrobial-resistance phenotype rather than one bacterial species ^[1].

CRE can cause pneumonia, bloodstream infection, urinary tract infection, wound infection, and meningitis. Infection must be distinguished from colonization, in which a person carries the organism without symptoms ^[1].

CRE are an important cause of healthcare-associated infection and a significant public-health threat because high antimicrobial resistance makes infections difficult to treat. Resistance determinants may also spread between bacteria through mobile genetic elements ^[2].

CRE can spread through person-to-person contact involving contaminated hands, wounds, or stool, and through contaminated medical equipment or devices. Colonized people can carry the organism without active infection and may still be relevant to infection-control assessment ^[1].

Risk is highest among patients in healthcare settings, especially people who require ventilators, urinary catheters, or intravenous catheters, receive long courses of certain antibiotics, or have weakened immune systems. Healthy people usually do not develop CRE infection ^[1].

Prevention includes hand hygiene, appropriate healthcare safety practices, careful use of antibiotics, early recognition, and facility-level infection-prevention and control measures. WHO places infection prevention and control at the center of efforts to limit occurrence and spread in healthcare facilities ^[1][2].

Laboratory testing and public-health surveillance are used to identify resistant isolates, measure resistance, and track transmission in healthcare settings ^[1]. The time series on this site reports notifications under each country's surveillance definition and cadence; infection counts should not be interpreted as estimates of all colonized people or compared across countries without considering those reporting differences.

1. 1 US CDC. About Carbapenem-resistant Enterobacterales (CRE) | CRE | CDC [Internet]. cited 6 Aug 2026. Available from: https://www.cdc.gov/cre/about/index.html
2. 2 World Health Organization. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities [Internet]. cited 6 Aug 2026. Available from: https://www.who.int/publications/i/item/9789241550178
3. 3 Ma J et al. Global spread of carbapenem-resistant Enterobacteriaceae: Epidemiological features, resistance mechanisms, detection and therapy. Microbiol Res. 2023 Jan. PMID: 36356348. doi: 10.1016/j.micres.2022.127249. PubMed: https://pubmed.ncbi.nlm.nih.gov/36356348/