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healthcare-associated infections (HAI) program

Carbapenem-resistant Enterobacterales (CRE)

Enterobacterales are an order of bacteria that are normally found in the human gut, and known to cause serious infections in the blood, lungs (pneumonia),  urinary tract and wounds. Some examples of these bacteria include E. coli, Klebsiella pneumoniae, and Enterobacter cloacae.


Frequently Asked Questions

What are CRE?

Carbapenem-resistant Enterobacterales (CRE) are resistant to last-resort antibiotics called carbapenems.

Why are CRE a problem?

CRE can spread from patient to patient in healthcare settings like hospitals and nursing homes. There are limited antibiotic treatment options for patients who develop infections caused by CRE. Patients with CRE infections have significantly worse outcomes than patients with non-carbapenem-resistant infections.

Who is at risk of getting CRE?

In general, healthy people are not at risk of CRE. People who have spent time in healthcare facilities like hospitals or nursing homes are at the highest risk of becoming carriers of CRE and developing CRE infections.
Risk factors for CRE include:

  • Being on a mechanical ventilator (breathing machine)
  • Having indwelling medical devices such as urinary catheters or endotracheal  tubes.
  • Recent stay at a long-term acute care hospital or a ventilator-equipped nursing facility
  • Recent overnight stay at a healthcare facility outside the United States

How are CRE spread?

There are 4 ways CRE can spread:

  • Direct person-to-person contact through contact with wounds or stool (poop)
  • Indirect person-to-person contact via the hands or clothing of healthcare providers
  • Medical devices for treatment of other conditions, such as endoscopes
  • During surgery

What can patients and families do to prevent CRE infections?

Patients and families can take several important steps to help prevent drug-resistant infections like CRE. Make sure to:

  • Tell your doctor if you have ever been diagnosed with a drug-resistant infection, or hospitalized elsewhere, especially outside of the United States.
  • Take antibiotics only as prescribed.
  • Expect all 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.
  • In many healthcare settings, healthcare personnel will wear gowns and gowns when interacting with patients with CRE.

If you have CRE or are caring for someone who does, make sure to clean your own hands and practice good hygiene. This is especially important during the following activities:

  • Before preparing or eating food
  • After using the bathroom
  • Before and after changing wound dressings or bandages
  • After blowing your nose, coughing, or sneezing

Should family members or other close contacts of patients be tested for CRE?

CDPH does not recommend family members or otherwise healthy close contacts of patients with CRE infection or colonization be tested for CRE. In general, healthy people are not at risk of CRE and do not need to be tested.

What can healthcare facilities and public health departments do to prevent CRE transmission?

Preventing the spread of CRE and other antibiotic-resistant bacteria is essential to patient safety and making sure antibiotics continue to work in the future. Healthcare providers and public health practitioners should visit the CDPH Carbapenem-resistant and Carbapenemase-producing Organisms webpage to learn more about how healthcare facilities and public health departments can prevent transmission of drug-resistant pathogens like CRE. Local health departments can view the CDPH CRE Quicksheet (PDF) when working with facilities to prevent CRE transmission in their jurisdiction.


Additional CRE Resources

For additional information contact the HAI Program at
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