What is Carbapenem-resistant Enterobacterales?

Carbapenem-resistant Enterobacterales are a group of bacteria that are highly resistant to antibiotics. Klebsiella species, Enterobacter species, and Escherichia coli are examples of Enterobacterales. These organisms are a normal part of the human gut bacteria, but can become resistant to carbapenem antibiotics. Enterobacterales can be resistant to antibiotics through several different mechanisms. Currently, the most urgent type of CRE is Carbapenemase-producing Carbapenem-resistant Enterobacterales (CP-CRE). CP-CRE are of increased public health concern due to the mobility carbapenemases, increased risk of transmission, extensive drug resistance, and increased mortality. CRE and CP-CRE can colonize in the gut  meaning the organism can be found in or on the body but is not causing an infection. A patient that is colonized can continue to spread the organism without showing symptoms. An infection occurs when the organism invades a body site and causes signs and symptoms of disease. CRE can cause infection in almost any part of the body including, but not limited to, urinary tract infections, bloodstream infections, respiratory tract infections, and wounds and abscesses.

IDOH Quick Facts- CRE

What is Carbapenemase-producing Carbapenem-resistant Enterobacterales?

Carbapenemase-producing Carbapenem-resistant Enterobacterales (CP-CRE) are CRE that use a carbapenemase enzyme as a resistance mechanism against carbapenem antibiotics. CP-CRE carry a gene for carbapenemase production. There are different genes that produce a carbapenemase but most often it is one of the major 5 - Klebsiella pneumoniae carbapenemase (KPC), New Delhi Metallo-beta-lacatamase (NDM), Verona Integro-Encoded Metallo-beta-lactamase (VIM), Imipenemase (IMP), and Oxacillinase-48 (OXA-48). These genes are often carried on a plasmid which can be transferred horizontally to other bacteria.

Laboratories can test for carbapenemase production through two different methods. Phenotypic tests include CarbaNP, mCIM and Modified Hodge Test and result in a positive or negative results. Genotypic or molecular identification tests for the specific gene responsible for carbapenemase testing and will show detected or not detected for each gene tested.

CP-CRE are reportable in Indiana for providers and laboratories. See the reporting resources below for more information on how to report.