Table 2.

Reasons why the recent emergence of carbapenem-resistant Enterobacteriaceae and their related superbugs is a serious public-health concern

(1) While HAIs caused by CRE are relatively uncommon, their incidence both in the United States and globally is increasing, posing a growing public health threat[16,19,25,32]

(2) Strains of Enterobacteriaceae that are responsible for HAIs are becoming CRE at an alarming rate

(3) Infections of the bacterial strains that have emerged as CRE were once treatable with carbapenems, but are no longer, even though these antibiotics have been reserved by clinicians as a “last resort” or “last line” of defense for treating patients infected with multidrug-resistant bacteria

(4) CRE’s resistance to carbapenems significantly limits the number of available treatment options

(5) Those very few antibiotics that remain effective for treating CRE infections are generally undesirable because, among some other limitations, they can be nephrotoxic

(6) Some strains of CRE are pan-resistant (meaning they cannot be treated using any type of antibiotic)

(7) The mortality rate of infections caused by CRE and related superbugs is relatively high (compared to carbapenem-susceptible Enterobacteriaceae), causing the death of as many as 50% of patients with a bloodstream infection of CRE

(8) Not only are the number of patient deaths attributed to CRE infection (from all causes, not just bacteremia) significant, both in the United States and globally, but also the rate of death among patients with CRE infections (primarily of the bloodstream) has been reported to be as much as 2 times higher than that of patients infected with carbapenem-susceptible Enterobacteriaceae[35]

(9) The genetic code that confers the antibiotic resistance of CRE and their related superbugs can be shared or exchanged with other bacteria of the same, or of even of a different, species (i.e., “gene swapping”)

(10) CRE and related superbugs are highly transmissible in the healthcare setting (and have the potential to spread in the community too)

CRE: Carbapenem-resistant Enterobacteriaceae; HAIs: Healthcare-associated infections.