The Council of State and Territorial Epidemiologists (CSTE) has released a position paper recommending that all states and territories enact laws to make carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CRE) reportable in their jurisdiction, noting that early detection and aggressive implementation of infection prevention and control strategies are necessary to prevent further spread of CRE.

Specific carbapenemase-producing CRE of concern include Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-β-lactamase (NDM), Verona integron-encoded metallo-β-lactamase (VIM), imipenemase (IMP) metallo-β-lactamase, and oxacillinase-48 (OXA-48). Cepheid’s Xpert Carba-R test is one option identified in the report for rapid detection and differentiation of these resistance mechanisms.

The paper indicates that laboratories should report CRE with all available quantitative and qualitative susceptibility data, results (positive, negative, intermediate) of phenotypic carbapenemase production tests as well as results (positive and negative) of any tests performed for resistance mechanisms (e.g., KPC PCR) to public health authorities. These authorities want to identify all CRE, whether they come from screening or from clinical cultures.

CSTE works to establish more effective relationships among state and other health agencies. It also works to advance public health policy and provides technical advice and assistance to partner organizations and to federal public health agencies such as the Centers for Disease Control and Prevention.

Early detection and aggressive implementation of infection prevention and control strategies are necessary to prevent further spread of CP-CRE.”

CSTE position statement 17-ID-04: Public Health Reporting and National Notification of Carbapenemase Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) for E. coli, Klebsiella spp. and Enterobacter spp.