Improved Phenotype-Based Definition for Identifying Carbapenemase Producers among Carbapenem-Resistant Enterobacteriaceae.
Preventing transmission of carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (CP-CRE) is a public health priority. A phenotype-based definition that reliably identifies CP-CRE while minimizing misclassification of non-CP-CRE could help prevention efforts. To assess possible definitions, we evaluated enterobacterial isolates that had been tested and deemed nonsusceptible to >1 carbapenem at US Emerging Infections Program sites. We determined the number of non-CP isolates that met (false positives) and CP isolates that did not meet (false negatives) the Centers for Disease Control and Prevention CRE definition in use during our study: 30% (94/312) of CRE had carbapenemase genes, and 21% (14/67) of Klebsiella pneumoniae carbapenemase-producing Klebsiella isolates had been misclassified as non-CP. A new definition requiring resistance to 1 carbapenem rarely missed CP strains, but 55% of results were false positive; adding the modified Hodge test to the definition decreased false positives to 12%. This definition should be considered for use in carbapenemase-producing CRE surveillance and prevention.
Nora
N
Chea
Sandra N
SN
Bulens
Thiphasone
T
Kongphet-Tran
Ruth
R
Lynfield
Kristin M
KM
Shaw
Paula Snippes
PS
Vagnone
Marion A
MA
Kainer
Daniel B
DB
Muleta
Lucy
L
Wilson
Elisabeth
E
Vaeth
Ghinwa
G
Dumyati
Cathleen
C
Concannon
Erin C
EC
Phipps
Karissa
K
Culbreath
Sarah J
SJ
Janelle
Wendy M
WM
Bamberg
Alice Y
AY
Guh
Brandi
B
Limbago
Alexander J
AJ
Kallen
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics* / Q000378:metabolism; D015780:Carbapenems / Q000494:pharmacology; D003140:Communicable Disease Control / Q000592:standards; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D003955:Diagnostic Tests, Routine / Q000592:standards; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D006801:Humans; D010641:Phenotype; D062486:Public Health Surveillance; D014481:United States / Q000453:epidemiology; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase
CRE; EIP; Emerging Infections Program; Enterobacteriaceae; United States; antimicrobial resistance; bacteria; carbapenem-resistant; carbapenemase; carbapenemase producers; enterobacteria; enterobacterial infection; identification; prevention; surveillance