What Are CRE 'Superbug' Infections?

Medically Reviewed by Jennifer Robinson, MD on May 02, 2023
3 min read

They're dangerous. They're tough to treat. They're "superbugs."

Carbapenem-resistant Enterobacteriaceae (CRE) are part of a group of germs that live in the intestines of some people. They're related to E. coli, but it is normal to have E. coli in your intestine and stool. The problem happens when these germs mutate and become resistant to antibiotics. Some CRE are resistant to so many medications that they are untreatable, and up to half of patients infected may die. This is particularly worrisome because carbapenems used to be one of the only antibiotics that could successfully treat another Enterobacter “superbugs.” 

 The trouble happens when CRE germs move outside your gut. They can cause deadly infections in your bloodstream, lungs, and urinary tract, including pneumonia and meningitis.

 The spread of superbugs like these -- typically in people who are sick, hospitalized, or living in a nursing home -- is a growing concern. In the U.S., nearly 3 million people get them each year, and experts say we're running out of drugs to treat them. These kinds of germs develop when people and animals use antibiotics they don't need. Highly resistant germs may be caused by prolonged use of antibiotics in frail patients, indiscriminate use in livestock, as well as loose prescribing practices.

They spread from person to person. You can pick them up if you come in contact with the stool or a wound of someone who's infected. If you're healthy, chances are you won't get sick when you're exposed to the germs, but there is a chance that you might spread it to someone with less reserves than you. Also, bear in mind that these bugs are associated with infections in the hospital, healthcare facilities, and nursing homes.

CRE are very dangerous for people in hospitals and nursing homes who have weakened immune systems or tubes going into their bodies.

In health care centers, CRE can hitch a ride on the hands of doctors and nurses. The germs can also live on door knobs, light switches, blood pressure cuffs, thermometers, breathing tubes, and catheters.

In rare cases, people have gotten infected from an instrument called a duodenoscope. It's used to find problems with the liver and bile ducts, near your intestines, and it's hard to clean. Germs hiding on the scope can pass from one person to another.


CRE are resistant to most drugs. These germs make an enzyme that breaks down antibiotics before they can work. That's why the strongest of those drugs, called carbapenems, may not cure the infection.

Your doctor may still give you antibiotics when you have CRE. They'll get lab tests to see which drugs have the best chance of working on it.

Hospitals are working hard to prevent them and stop them from spreading. You can take steps to protect yourself, too:

  • Be sure your doctors, nurses, and other health care providers wash their hands with soap and water or an alcohol-based hand rub before touching you or tubes going into your body. They should also wear gloves and a gown in your hospital room.
  • Wash your own hands often, especially after using the bathroom, touching bandages or dressings, and before eating.
  • Tell your doctor if you've been in a hospital outside the U.S. Some antibiotic-resistant bacteria are more common in other countries.

If you're caring for someone with a CRE infection, you probably won't get it. But to be safe, you should wash your hands often, especially after treating a wound, helping them to the bathroom, or touching a tube in their body, like a catheter. Always wear gloves when doing these things.