Clarifying CRE Reporting in NHSN

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Presentation transcript:

Clarifying CRE Reporting in NHSN April 20, 2016 Rosalie Giardina, MT (ASCP) Bureau of Healthcare Associated Infections (BHAI) AR/CRE Coordinator

Carbapenem-Resistant CRE Carbapenemase-Producing CRE Clarifying CRE Reporting in NHSN Are the terms Carbapenem-Resistant CRE and Carbapenemase-Producing CRE synonymous with each other? Yes or No

NO Clarifying CRE Reporting in NHSN Carbapenem-resistant CRE are any isolates that are resistant to a carbapenem antibiotic i.e., ertapenem, imipenem, meropenem, doripenem These may or may not be carbapenemase-producing Carbapenemase-producing CRE are those isolates that are resistant to a carbapenem antibiotic AND produce a carbapenemase enzyme (mechanism of resistance)

Phenotypic Screening Tests for Carbapenemase Clarifying CRE Reporting in NHSN Phenotypic Screening Tests for Carbapenemase Identifies the presence of the classes of carbapenemases without distinction Class A = KPC (main representative) Class B = metallo β-Lactamases (MBL)= NDM-1, VIM and IMP Class D = OXA carbapenemases Modified Hodge Test – detects mostly KPC and SME-1 (Serratia marcescens) Carba NP – detects carbapenemase classes A, B and D

Phenotypic Screening Tests for Carbapenemase Clarifying CRE Reporting in NHSN Phenotypic Screening Tests for Carbapenemase Therefore, If you test for carbapenemase using MHT, Carba-NP, MBLe, or MBLs, and you get a POSITIVE test result, The answer for: ‘Did the isolate test positive for a carbapenemase’ should be either: (NS-Carba) Nonspecific carbapenemase activity (e.g., MHT or Carba-NP) (NS-MBL) Nonspecific metallo-β-Lactamase activity (MBL E-test or MBL-screen)

Genotypic testing Phenotypic testing

CRE Isolate Testing in New York State Please remember to ask for, and link travel history, to a patient’s CRE status CDC HEALTH ADVISORY Distributed via the CDC Health Alert Network February 14, 2013, 12:30 ET “When a CRE is identified in a patient (infection or colonization) with a history of an overnight stay in a healthcare facility (within the last 6 months) outside the United States, send the isolate to a reference laboratory for confirmatory susceptibility testing and test to determine the carbapenem resistance mechanism.”