Denmark reports increase in Carbapenem-resistant Enterobacterales (CRE) in hospitals

Multi-resistant intestinal bacteria are a growing problem in Danish hospitals. From 2022 to 2023, the number of cases of infection with CRE bacteria has increased by 43 percent, new figures from the Statens Serum Institut (SSI) show.

In 2023, there were 436 cases of CRE infection in Denmark, which corresponds to an increase of 43 percent compared to 304 cases of infection the year before. The bacteria are typically found in the gut and are resistant to meropenem or another carbapenem, which are some of our most important types of antibiotics to treat critically ill patients with.

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Healthy people have only a small risk of becoming seriously ill if they become infected with the bacteria. The risk is greatest for patients who are already weakened or have a reduced immune system as a result of, for example, a serious cancer and a long course of treatment.

"It is the combination of a particularly vulnerable patient and long-term treatment with antibiotics that can lead to a CRE infection. The bacteria can become dangerous when they leave their normal environment in the gut and end up in the bloodstream, where they cause blood poisoning. When our usual antibiotic treatment does not work because we were not prepared for the fact that the infection was caused by a resistant bacteria, it can become critical with a CRE bacteria in the blood.”

Ute Wolff Sönksen, senior physician at the Reference Section for Antibiotic Resistance at SSI 

CRE bacteria are found both in clinical samples from patients, but also in so-called environmental samples from e.g. hospital toilets. Environmental samples are taken when several cases of CRE bacteria have been found among patients on the same bed section. Despite massive efforts with screening and cleaning in Danish hospitals, there were still more CRE outbreaks in 2023 than in 2022.

"It is worrying that CRE is increasingly found in Danish hospitals. The number of outbreaks with CRE is now at a level where it is beginning to take up a lot of everyday life in some of the hospital wards, and here many resources are being used to limit the occurrence.”

Anne Kjerulf, Senior Physician, Central Unit for Infection Hygiene, SSI

CRE infections are difficult to treat. They are resistant to most antibiotics, including carbapenems, drugs often used to treat multidrug-resistant bacterial infections. Healthcare providers make treatment decisions for CRE infections on a case-by-case basis. If your provider prescribes antibiotics, take them exactly as instructed and finish the full course, even if you feel better.

Colonized patients often do not require treatment.