2017 Carbapenem-resistant Enterobacteriaceae Laboratory Reporting
Carbapenem-resistant Enterobacteriaceae (CRE) are an important target for infection prevention, due to their ease of spread and high mortality.
In 2014 Connecticut made CRE a laboratory reportable condition. However, it has been recognized both in Connecticut and nationally that this case definition is complex, and potentially difficult for laboratories to implement. In addition, a variety of case definitions have been implemented in different states and jurisdictions. Therefore, a working group was created by the Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial Epidemiologists (CSTE) to develop a revised definition for CRE to meet these objectives:
Provide comparable measures of CRE both within and across public health jurisdictions to facilitate reporting of CRE data to professional audiences, policy makers, and the public.
Establish actionable epidemiology for healthcare facilities about CRE detection and response.
Accordingly, in June 2015, CSTE adopted a new CRE case definition and recommends it for state reporting. CDC has concurred with this recommendation, and Connecticut has adopted this change to reporting for Connecticut beginning January 1, 2016.
Purpose of surveillance change:
To simplify and align CRE reporting in Connecticut with the new and updated national surveillance standards recommended by CSTE and CDC that will be adopted by other states improving comparability across jurisdictions
To simplify the reporting requirements through the adoption of breakpoints adopted by Clinical and Laboratory Standards Institute (CLSI)
To simplify and streamline the reporting requirements by removing consideration of cephalosporin sensitivity that was a complicated component of the 2014-2015 CRE case definition in Connecticut
To recognize the increasing ability of laboratories to perform non-culture based testing methodologies and to ensure that CRE cases identified by these means are included in state surveillance
To obtain information regarding genotypic testing results that enable classification of cases according to recognized resistance mechanisms and carbapenemase production, which will foster improved case ascertainment and provide clarification for infection control recommendations
2016 CRE Case Definition:
Identification of any Enterobacteriaceae (using culture or non-culture based methodologies) collected from a clinical site (e.g., sterile site, sputum, and urine, but not stool) resistant to any tested carbapenem (minimum inhibitory concentrations of =4 mcg/ml for meropenem, imipenem, and doripenem or = 2 mcg/ml for ertapenem) and/or that exhibit production of a carbapenemase (e.g., KPC, NDM, VIM, IMP, OXA-48) demonstrated by a recognized test (e.g., polymerase chain reaction, modified Hodge test (MHT), Carba NP, or metallo-ß-lactamase testing (e.g., MBL E-test or other screening method)). For Proteus spp., Providencia spp., and Morganella spp. which can be intrinsically non-susceptible to imipenem, results for carbapenems other than imipenem must be used to determine if an isolate meets the CP-CRE definition.
Carbapenem-Resistant Enterobacteriaceae (CRE) Reporting Flowchart - 2016
To contact the Healthcare Associated Infections Program, please call 860-509-7995.