Health Alerts, Advisories, Notifications, and Updates

Surveillance

  • Case Definition: A culture yielding a bacterium in the family Enterobacteriaceae (e.g. Klebsiella, Enterobacter, Escherichia coli, Proteus, Serratia, etc):
    • that tests resistant to at least one carbapenem antibiotic (minimum inhibitory concentrations of > 4mcg/ml for meropenem, imipenem, and doripenem OR > 2mcg/ml for ertapenem); or
    • that is documented to produce a carbapenemase by means of a laboratory test.  Tests shall include but not be limited to, MicroScan, E-test, disk diffusion test, Modified Hodge Test (MHT), Metallo-β-lactamase test, Carba NP, Carbapenem Inactivation method (CIM), Modified CIM (mCIM), polymerase-chain reaction (PCR), and GeneXpert CarbaR. 
  • PDPH Quarterly CRE Reports
  • National Surveillance Data on CRE (CDC)

Vaccine Information

  • There is currently no vaccine to prevent CRE.

Diagnostics and Treatment

  • CRE infection is diagnosed through a culture of the affected body site. CRE infection can be treated with antibiotics, but these bacteria are frequently resistant to many antibiotic drugs. Providers should order antimicrobial susceptibility testing (AST) to determine the appropriate drug for treatment. 
  • Extended AST is available through the CDC’s Antibiotic Resistance Lab Network (ARLN) for pandrug-resistant CRE isolates. Please email or call the HAI/AR team at (215) 685-4501 to coordinate isolate submission for extended AST testing. 
  • CRE colonization is primarily identified through a culture or a PCR based test from a rectal swab. Treatment of CRE colonization is not recommended.
  • Retain CRE isolates for one month following identification and report cases to PDPH.  PDPH will follow up to coordinate further testing if indicated.

Reporting to PDPH

Report all CRE cases (colonization or infection) to the Philadelphia Department of Public Health by completing and faxing the CRE Report Form to 215-238-6947 or calling 215-685-6748 during business hours within 5 days.

Health Educational Materials

  • PDPH Drug Resistant Organism Fact Sheet for Long-Term Care - Coming Soon!

Links and Resources

Guidelines for Management and Control

CDC GUIDELINES:

HOSPITALIZED PATIENTS:  

  • CRE patients shall be placed on contact precautions and in a private room for the duration of all current and future healthcare stays. 
  • Because patients may remain colonized for more than one year, do not discontinue precautions when the infection clears. There is not enough evidence to make a firm recommendation about when to discontinue use of Contact Precautions for infected or colonized patients.
  • Inter-facility transfer: Prior to patient transfer, the transferring facility should notify the receiving facility of the CRE colonization or infection.

LONG TERM CARE FACILITY RESIDENTS:

  • CRE patients shall be placed on contact precautions or enhanced barrier precautions and placed in a private room, if available, for the duration of all current and future healthcare stays. 
  • If CRE patients cannot be placed in a private room, in room isolation precautions should be implemented. 
  • Because patients may remain colonized for more than one year, do not discontinue precautions when the infection clears or antibiotic course is completed. 
  • Inter-facility transfer: Prior to patient transfer, the transferring facility should notify the receiving facility of the CRE colonization or infection.

DISINFECTION GUIDANCE:  

  • Reusable equipment should be dedicated to the colonized or infected patient whenever possible.
    • Shared reusable medical equipment should be disinfected immediately after use.  
  • Daily disinfection, with products appropriate for CRE, that includes areas in close proximity to the patient, high-touch surfaces in the room, as well as surfaces around sinks and toilets. 
  • Immediate cleaning and disinfection of equipment or surfaces contaminated with blood, serum, urine, purulent discharges, feces, and other bodily fluids or infectious materials.
  • Terminal cleaning shall consist of thorough wet cleaning and disinfection. Specific products should be utilized based on the identified organism.  

Updated: 11/01/2019