---
title: CRE - Deadly, but not the strongest survivor
description: CRE - Deadly, but not the strongest survivor
---

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## CRE - Deadly, but not the strongest survivor

<http://static1.squarespace.com/static/595689fc9de4bbc892200518/t/59568aca5fd63b5f29287742/1498845240763//img.jpg.com/static/595689fc9de4bbc892200518/t/59568aca5fd63b5f29287742/1498843850134/1000w/>

Clinical microbiologists, Infection Preventionists and  
 Infectious Disease experts all agree that multidrug-resistant gram-negative  
 bacteria pose the greatest risk to public health. The reasoning is 2-fold. First,  
 resistance development occurs faster in  gram-negative bacteria than gram-positive  
 bacteria, but perhaps most importantly there are fewer new antibiotics coming to  
 market that are active against gram-negative bacteria.  If we combine this with the fact that over  
 the past decade we have been able to prove that the environment plays a large  
 role in the spread of most of the key hospital-associated infections, this means that we  
 need to better understand the ability of these key pathogens to survive on  
 surfaces and infect our patients.

[CRE](http://www.cdc.gov/HAI/organisms/cre/) in  
 particular is a concern due to the fact that CRE infections are difficult to  
 treat with mortality rates of 40% - 50%!    
 Due to CRE's impact as a public health threat, [Weber et al conducted a  
 study](http://www.ncbi.nlm.nih.gov/pubmed/25661968) that investigated the frequency and location of environmental  
 contamination of CRE and the ability of CRE to survive on surfaces.

For the first part of the study, the researchers sampled  
 surfaces such as bed rails, overbed tables, chair arms, sinks, toilets,  
 bathroom floor, supply/medicine carts and the tops of the linen hampers in 15 rooms  
 of patients colonized or infected with CRE.   
 The cultures found 6 different strains of *Enterobacter* spp. and a strain  
 of *Klebsiella pneumoniae* and found  
 that only 8.4% of the surfaces were contaminated, with bed rails, sinks and  
 toilets being associated with the most frequently contaminated.

The second part of the study looked at the survival ability  
 of CRE strains of *K. pneumoniae, E.coli*  
 and *Enterobacter* sp. when inoculated  
 on overbed tables, vinyl surfaces, stainless steel, Formica and cloth.  With the exception of Klebsiella on Formica,  
 all 3 pathogens showed <15% survival rate at the 24 hr mark, <5% at the  
 48 hr mark and 0% at 72hrs.  Further *E. coli* did not survive as well as *K. pneumoniae* or *Enterobacter* spp.

Overall, the study showed that CRE is infrequently isolated  
 from environmental surfaces in rooms of infected patients, and if isolated, is  
 only found in small numbers.  These results suggests that CRE does not survive well in the environment in comparison  
 with other key hospital-associated pathogens such as [MRSA](http://infectionpreventionresource.com/files%5CMRSA%20Fact%20Sheet%205.19.Rev1.pdf),  
[VRE](http://infectionpreventionresource.com/files%5CVRE%20Fact%20Sheet%205.19.Rev1.pdf),  
[C.diff](http://infectionpreventionresource.com/files%5CC%20%20diff%20Fact%20Sheet%205.23.Rev1.pdf),  
[MDR *Acinetobacter*](http://wwwnc.cdc.gov/eid/article/11/1/pdfs/04-0001.pdf) spp and [MDR *Pseudomonas*](http://www.medscape.com/viewarticle/515330).

Without a doubt, CRE is a growing concern and significant  
 public health threat, however we may be able to breathe a little easier knowing  
 that it appears the environment may play a less important role in the  
 transmission of CRE.  It's certainly not  
 conclusive.....but it could be a glimmer of a light at the end of a long and  
 dark tunnel in understanding how to manage CRE.

*Bugging Off!*

Nicole

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