New Toolkit Addresses CRE Control and Prevention

Montefiore Medical Center, in partnership with Boston University School of Public Health, today announced the launch of a toolkit to help prevent and control the emergence of a dangerous and highly contagious infection in healthcare settings. The Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit was funded by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) and aims to provide intervention guidelines for healthcare professionals, acute- and long-term-care hospitals and health departments across the country. The toolkit is available on the AHRQ website at:

In recent years, a “superbug” called carbapenemase-producing Klebsiella pneumoniae (KPC), which is extensively antibiotic resistant, has been identified as the cause of many lethal healthcare-associated infections. In the first half of 2012, nearly 200 long-term acute care and short-stay hospitals in the United States had at least one CRE infection. Although these infections are not common, their rise is alarming because they kill up to half of people who get severe infections from them, according to the Centers for Disease Control and Prevention (CDC).

“The appearance of KPC in healthcare settings is a serious challenge to all medical professionals and it’s an area that requires significant attention to ensure patient safety,” says Brian Currie, MD, MPH, vice president and medical director for research at Montefiore Medical Center and professor of clinical medicine, Department of Medicine (Infectious Diseases) and Department of Epidemiology & Population Health at Albert Einstein College of Medicine of Yeshiva University. “Our goal is to share our successful KPC interventions to help other institutions establish effective prevention programs.”

KPC first emerged in North Carolina in 1999. By 2013, it had been documented in 42 states and reached endemic levels in six states and around the world. KPC colonization is routinely found in patients in both acute- and long-term-care facilities and additional risk factors include recent treatment with broad-spectrum antibiotics and advanced age. According to a 2010 study, overall mortality for patients infected with KPC was 23 percent in seven days, 42 percent in 30 days and 60 percent for those hospitalized more than 30 days.

“This toolkit guides clinicians through the process of implementing an intervention, including readiness assessment, goal setting, implementation and measurement,” says Currie. “At Montefiore, we detected KPC with a rapid molecular lab test, which resulted in immediate initiation of contact isolation for all positive patients. We virtually eliminated patient-to-patient transmission of KPC as a result of the implementation of the measures outlined in this toolkit.”

The AHRQ toolkit complements the CDC’s recommendations for preventing CRE in healthcare settings. It includes practical tools that are customizable to meet the needs of local hospitals. Key recommendations include enhancing screening to identify colonized patients, hand hygiene compliance and placing those testing positive on contact isolation precautions, minimizing use of invasive medical devices and promoting antibiotic stewardship.

“It is extremely concerning that we’ve been seeing such a dramatic increase in the spread of KPC, the most common type of CRE in the U.S. during the past 10 years,” says Currie. “It is more crucial than ever for healthcare professionals to take steps to control the prevalence of KPC in order to protect their patients and their communities.”

Source: Montefiore Medical Center