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LINCOLN COUNTY, N.C. — There have been three confirmed cases of the “Superbug” CRE at Carolinas HealthCare System-Lincoln this year, according to a hospital spokesperson.

WSOC reported that two were infected outside of the hospital and the third victim was infected inside Carolinas Health Care System-Lincoln, according to the hospital.

“CRE, which stands for carbapenem-resistant Enterobacteriaceae, are a family of germs that are difficult to treat because they have high levels of resistance to antibiotics,” according to the Centers for Disease Control and Prevention.

CHS has taken steps to address the infections, including using decontamination procedures and protocols that go beyond industry standards. The hospital said they are actively performing CRE screenings for patients at highest risk.

What is CRE?

It’s what CDC epidemiologists call carbapenem-resistant Enterobacteriaceae which kill up to half the patients who contract them.

CRE is a family of bacteria usually found in hospitals and other health care facilities that has evolved a huge resistance to antibiotics.

CRE can be so deadly, because few antibiotics work against its different variations. That’s what the name “carbapenem-resistant” means — carbapenem is a class of antibiotics often used as a last resort against a bad bacterial infection.

But they are no match for CRE, the Centers for Disease Control and Prevention said.

Are these formerly unknown bacteria?

Not really; they are bacteria that just evolved.

The superbug family includes Klebsiella and E. coli, which people have naturally in their intestines. But when they spread to other parts of the body, they can wreak havoc.

Some CRE make an enzyme called Klebsiella pneumoniae carbapenemase that destroys those strong antibiotics. The enzyme seems to be a pretty new adaptation; researchers first discovered it in 2001.

How can you get it?

You don’t get it, when somebody sneezes on you. You have to touch an infected wound or stool, then touch a vulnerable part of the body — like an open wound.

That’s why it doesn’t spread on the street but instead in hospitals, where health care workers and others can spread it by touch.

Someone may forget to wash their hands after coming in contact with stool or a wound. Or a procedure could be performed with a contaminated instrument, like an endoscope or a surgical device.

But CRE can also spread from other soiled invasive medical inserts like respirator tubes or catheters. Those infected are usually patients being treated for some other ailment. These patients have underlying health conditions, which may have left them more susceptible to CRE and other infections.

But some researchers warn that CRE could spill over into the streets, too, if they become more widespread in hospitals.

Does the procedure those patients had present a particular infection risk?

No, said the American Society for Gastrointestinal Endoscopy.

The procedure is called endoscopic retrograde cholangiopancreatography or ERCP. It is used among other things to unblock bile ducts and take care of pancreas issues.

“It is estimated that more than 500,000 ERCPs are performed each year in the U.S.,” ASGE said. “From what we know, over the past few years, there have been fewer than 100 known cases of transmission of these problematic bacteria through ERCP.”

Do any antibiotics work against them?

Yes, but not many. And some that do can cause kidney damage.

But they’re only part of the treatment. Caregivers also remove some bacteria by draining off the abscess.

Some CRE strains have been reported that are resistant to all antibiotics. On the other hand, some people contract the bacteria without an infection ever breaking out.

Is there any good way to fight their spread?

Cleanliness in all things is important.

Wash hands, sterilize instruments. If you’re a patient in a hospital, remind staff to do the same, and don’t share a room with an infected patient, the CDC said.

Also, if you come down with a harsh bacterial infection after medical treatment in another country, be sure to tell your health care provider about that treatment. Some CRE are more common overseas than in the United States.

Also, some researchers believe doctors should be careful not to prescribe antibiotics too quickly.

The ubiquitousness of antibiotics led superbugs to develop resistance to them in the first place, according to many experts.