Improved phenotype-based definition for identifying carbapenemase producers among carbapenem - Resistant enterobacteriaceae

Nora Chea, Sandra N. Bulens, Thiphasone Kongphet-Tran, Ruth Lynfield, Kristin M. Shaw, Paula Snippes Vagnone, Marion A. Kainer, Daniel B. Muleta, Lucy Wilson, Elisabeth Vaeth, Ghinwa Dumyati, Cathleen Concannon, Erin C. Phipps, Karissa Culbreath, Sarah J. Janelle, Wendy M. Bamberg, Alice Y. Guh, Brandi Limbago, Alexander J. Kallen

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1611-1616
Number of pages6
JournalEmerging Infectious Diseases
Volume21
Issue number9
DOIs
StatePublished - Sep 1 2015
Externally publishedYes

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases
  • Epidemiology

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