About CRO

Carbapenem-resistant organisms, or CROs, are a type of multidrug-resistant organism that can cause both infection and colonization in health care settings.

Enterobacterales are a family of bacteria normally found in the bowels and the feces. Carbapenems are one of our strongest class of antibiotics. CRE are Carbapenem-resistant Enterobacterales that are highly resistant to many antibiotics and may be difficult or impossible to treat. CRO are Carbapenem-resistant organisms that include CRE and other bacteria such as Acinetobacter baumannii and Pseudomonas aeruginosa.

• Acinetobacter baumannii is an opportunistic organism that can affect people with compromised immune systems and is found in hospital environments.
• Pseudomonas aeruginosa is often multidrug resistant and associated with healthcare-associated infections

Carbapenem-Resistant Organisms (CROs) Fact Sheet

Can CRO be harmful?

CRO may live harmlessly in the intestines, respiratory tract or skin. This is called colonization. However, Enterobacterales, Acinetobacter baumannii or Pseudomonas aeruginosa can cause urinary tract infections, wound infections, pneumonia, blood stream infections and other serious infections.

Why should I care about CRO?

CRO can spread from one patient to another in hospitals and long-term care facilities. CRO is very difficult to treat. Patients with CRO infection can die from their infection. Hospitals and long-term care facilities can prevent spread if they are very careful about hand washing between patients and other infection prevention measures.

Who is at risk for getting a CRO infection?

Infections are most often seen in patients with prolonged hospitalization and those who are critically ill. Patients on ventilators (breathing machines), or with intravenous catheters or urinary catheters or wounds are more at risk. Patients who have received antibiotics are also more at risk.

How do people get CRO?

CRO is shed in the feces, urine or draining wounds of patients who are infected or colonized with the bacteria. Patient skin, hands and bedding are likely to be contaminated with the bacteria. Doorknobs, bedrails, light switches, toilets, bedpans, bedside commodes, and bathroom fixtures are also likely to be contaminated. Healthcare workers can spread CRO if they do not use gowns and gloves when coming into contact with the patient or items in the patient’s room, or if they do not wash their hands between patients. Equipment like blood pressure cuffs, thermometers and other devices can also become contaminated with CRO and spread the infection from one patient to another if they aren’t disinfected between uses.

How can I tell if someone has a CRO?

Patients who are infected with CRO have signs and symptoms of infection, but patients who are colonized have no symptoms. The healthcare facility should have a system to alert healthcare providers if someone is infected or colonized with a resistant organism.

Is there a treatment for CRO infections?

Very few antibiotics will be effective. A microbiology laboratory must run tests to determine which antibiotics will treat the infection.

What should I do if I am diagnosed with a CRO in a healthcare facility?

If you have a CRO you may be placed in a private room with your own toilet or commode. If a private room is not available, you will usually be placed in the same room with another patient who has a CRO. Always wash your hands with soap and water:

• Before eating
• After using the bathroom
• After coughing or sneezing
• After contact with wound drainage or other body fluids

You may be allowed to leave your room and socialize but you must:

• Wash your hands before leaving your room
• Keep any wounds covered
• Cover your cough and wash your hands after coughing or sneezing
• Follow any additional instructions from your doctor or nurse

You should also let your healthcare workers and healthcare facilities know if you have had a positive CRO result before. They can take special precautions to stop CRO spreading to other patients.

What happens when I am ready to leave the healthcare facility?

You can go home as soon as your doctor says you are ready, even if you have a CRO. If you are going to another hospital or nursing home, your nurse or doctor will let them know about your positive CRO result so that they can prevent spread to other patients.

What happens when I go home?

Clothes, bed linen and dishes can be washed as usual. It is always very important to wash your hands carefully after using the toilet and before preparing meals or eating to stop CRO spreading to other people. Also wash hands after coughing or sneezing, or after changing your dressing. Follow any other instructions your healthcare provider gives you.

Will I get rid of a CRO?

If you have a CRO infection, antibiotics may be available to treat your infection, but they may not clear CRO from the bowels, urine, wounds or respiratory tract. You may continue to be a CRO carrier and may need to continue to use precautions when you are in a healthcare facility. It is possible for a CRO carrier to spread CRO to someone else.

How can I prevent spreading CRO to my loved ones?

Most healthy people are at relatively low risk for problems with CRO, but they may become carriers. Make sure that anyone who comes into your house is careful about washing their hands, especially after contact with your wounds or helping you use the bathroom, or after cleaning up stool.

Caregivers should also make sure to wash their hands before and after handling any medical device (e.g., urinary catheters). This is particularly important if the caregiver is caring for more than one ill person at home. In addition, gloves should be used before contact with body fluids or blood. Everybody in your house (including you) should also wash hands with soap and water:
 

• Before eating
• Before preparing food
• After going to the bathroom
• Any time hands are visibly dirty