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Infection prevention and control team
Carbapenem-resistant
Enterobacteriaceae (CRE)
Information for patients
Introduction
This leaflet explains carbapenem-resistant enterobacteriaceae (CRE), a rare but important
hospital infection to be aware of. Please ask our team any questions you have about the
information below.
What is CRE?
CRE are a family of bacteria that usually live in the human gut without causing any problems or
symptoms. This is known as being a ‘carrier’ (sometimes called ‘colonisation’), and does not
require any treatment. Occasionally, CRE can get into other parts of the body such as the
bladder or bloodstream and cause serious infections, which can be life-threatening.
CRE are members of the Enterobacteriaceae family that are resistant to a group of antibiotics
(called carbapenems) that are usually prescribed to treat infections caused by these bacteria.
This means these infections cannot be treated by certain antibiotics. In a hospital, where there
are many vulnerable patients, spread of resistant bacteria can cause problems.
How will you test me for CRE?
An increasing number of patients admitted to hospital are now screened to check whether they
are carriers of CRE. Screening can happen at the time of admission, during your hospital stay,
or because you are at an increased risk of being a carrier. CRE screening requires a swab from
your rectum (back passage) or a stool sample because CRE live in the gut.
If a doctor or nurse thinks you have a CRE infection, a swab will be used to collect a specimen
from the site that is thought to be infected (such as a wound), which will be sent to the
laboratory.
What will happen if I have CRE?
If you are infected with or a carrier of CRE, we will usually place you in a single room while you
are in hospital, away from other patients. We may need to make special arrangements for your
care, for example, in scheduling planned procedures. Carriers are not usually treated.
If you are infected with CRE we will give you antibiotics. The type of antibiotics given will
depend on where you are infected and which antibiotics the CRE is sensitive to. It is important
for us to know if you are carrying CRE because if you develop an infection, we can choose the
right antibiotic straight away.
How did I get CRE?
It can be difficult to say when or where you picked it up. However, there is an increased chance
of picking up these bacteria if you have been a patient in a hospital abroad or in a UK hospital
that has had patients carrying the bacteria, or if you have been in contact with a carrier
Hospital patients with a weakened immune system or those who have had an operation or any
other invasive procedure are at a greater risk of getting an infection caused by CRE.
elsewhere.
How is the spread of CRE being controlled?
We can reduce the number of patients affected by CRE by following simple prevention and
control measures:
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thorough hand hygiene before contact with every patient
screening to identify patients who are carriers of CRE
using single rooms for patients infected with or carriers of CRE. If no singe rooms are
available, you may be cared for in an area where you are with other patient who also
have CRE
ensuring healthcare workers use contact precautions (gloves and aprons) when caring
for patients who are infected with or carriers of CRE
effective cleaning and disinfection of surfaces and equipment that may be contaminated
with CRE
The most important measure for you to take is to wash your hands regularly, especially after
using the toilet and before eating food. Avoid touching any areas of broken skin or wound
dressings and maintain good general hygiene.
As CRE does not usually cause infections in healthy people, hospital visitors are at a low risk of
CRE infection. However, visitors should wash their hands before and after touching you or your
immediate environment.
What happens after I go home?
While you may still be a carrier when you go home, no special measures or treatment are
required; any infection will have been treated prior to your discharge. You should carry on as
normal, maintaining good hand hygiene.
Before you leave hospital, ask the doctor or nurse to give you a letter or card advising that you
have had an infection or have been/are a carrier of CRE. This will be useful for the future and it
is important that you make healthcare staff aware of it. If you or a member of your household is
admitted to hospital, you should let the hospital staff know that you are or have been a carrier
and show them the letter/card.
Further information
Please speak to your doctor or nurse if you have any questions or concerns about CRE or other
aspects of your treatment. For general infection prevention and control information, please
contact the hospital’s infection prevention and control team on 020 3312 6201.
Or visit this website: https://www.gov.uk/government/publications/carbapenemase-producingenterobacteriaceae-non-acute-and-community-toolkit
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How do I make a comment about my visit?
We aim to provide the best possible service and staff will be happy to answer any of the
questions you may have. If you have any suggestions or comments about your visit, please
either speak to a member of staff or contact the patient advice and liaison service (PALS) on
020 3313 0088 (Charing Cross, Hammersmith and Queen Charlotte’s & Chelsea hospitals), or
020 3312 7777 (St Mary’s and Western Eye hospitals). You can also email PALS at
[email protected]. The PALS team will listen to your concerns, suggestions or queries and
is often able to help solve problems on your behalf.
Alternatively, you may wish to express your concerns in writing to:
Complaints department
Fourth floor
Salton House
St Mary’s Hospital
Praed Street
London W2 1NY
Alternative formats
This leaflet can be provided on request in large print, as a sound recording, in Braille, or in
alternative languages. Please contact the communications team on 020 3312 5592.
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Infection prevention and control team
Published: Nov 2016 (refreshed)
Review date: Nov 2019
Reference no: 2549
© Imperial College Healthcare NHS Trust