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

2. 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

3. 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)

4. 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

5. 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)

6. Genotypic testing
Phenotypic testing

8. 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.”