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Carbapenem-resistant Enterobacteriaceae (CRE)


CRE, defined as Enterobacteriaceae (Klebsiella sp., E. coli, and Enterobacter sp.) resistant to carbapenem antibiotics or that produce carbapenemases, are epidemiologically important healthcare-associated pathogens. Studies have shown that CRE infections are difficult to treat, as some have become resistant to all or almost all antibiotics. The mortality rate is high, and infection is easily spread between patients in healthcare facilities. Clinicians play a critical role in slowing the spread of CRE by rapidly identifying patients colonized or infected with these organisms and placing them on Contact Precautions when appropriate, using antibiotics wisely, and minimizing device use.    

On January 19, 2017, the Long Beach City Health Officer issued an Order requiring all acute care hospitals and skilled nursing facilities to report cases of CRE. In addition, acute care hospitals and skilled nursing facilities that generate antibiograms are required to submit them once a year to Public Health. For more information, please contact the Emerging Infectious Disease Response Coordinator at 562.570.4344.

Resources (PDFs)

CRE Clinician FAQ
CRE FAQ for Patients Eng
CRE Reporting FAQ LB
Interfacility Transfer Form 

Helpful Links

CDC CRE Toolkits
CDC CRE Info for Clinicians
CDPH  Adherence Monitoring

CDPH Toolkits:
Enhanced Standard Precautions for Skilled Nursing Facilities
Contact Precautions Adherence Monitoring Toolkit
Environmental Cleaning and Disinfection Adherence Monitoring Toolkit
Hand Hygiene Adhernce Monitoring Toolkit
Skilled Nursing Facility Antibiotic Stewardship Program Implementation Toolkit

LA County Public Health Resources:
Risk Assement Guidelines for Long Term Care Facilities
Carbapenemase Producing Organisms

Communicating with Patients and Families:
Resident and Family Admission Orientation Example Document
Example Acknowledgement Form 

Press Releases

County of Los Angeles Public Health - Drug-Resistant CRE Added to List of Reportable Diseases (1.19.17)
County of Los Angeles Public Health - Drug Resistant E. coli Bacteria Identified in LA County Resident (1.31.17)

Health Officer Updates

CRE Health Officer Order
CRE Facility Notification

Long Beach CRE Surveillance Data 

CRE Surveillance Report 2017
CRE Surveillance Report 2018
CRE Surveillance Report Q1, Q2 and Q3 2019

Long Beach CRE Prevention Collaborative (2018-2019)

Acute Care Hospitals
Skilled Nursing Facilities

Kick-off Meeting 3.13.18 General Overview Slides
1st Learning and Discussion Sesssion 6.6.18 Infection Prevention
2nd Learning and Discussion Session 9.26.18 Lecture, Game
3rd Learning and Discussion Session 1.24.19 Self-assessments
Antimicrobial Stewardship
Final Learning and Discussion Session 3.21.19 Self-assessments, New Developments, and CREag's Journey
Communication for Isolation Practices

AMR Challenge

We are pleased to announce we have made a commitment to the U.S. government’s Antimicrobial Resistance (AMR) Challenge, which is a year-long effort to accelerate the fight against antimicrobial resistance across the globe. The Long Beach Health Department’s commitment is as follows:

California’s Long Beach Department of Health and Human Services is committed to improving surveillance of antibiotic resistance by hosting a carbapenem-resistant Enterobacteriaceae (CRE) collaborative with the California Department of Public Health to create dialogue, education, and awareness among skilled nursing facilities and acute care hospitals. By December 2019, the Long Beach Department aims to have antibiotic resistance subject matter experts throughout many healthcare facilities. The Department made CRE reportable locally, and commits to finding new ways to detect outbreaks of resistant organisms more quickly and efficiently; ensure accurate and timely reporting of outbreaks of resistant organisms in local facilities; and monitor for novel multi-drug resistant organisms.

For information about the AMR challenge visit the CDC's website.

Last Updated: 7/17/19