Carbapenem-resistant Enterobacteriaceae (CRE)
CRE are defined as Enterobacteriaceae that are:
Nonsusceptible to one of the following carbapenems — doripenem, meropenem, or imipenem AND
- Resistant to all of the following third-generation cephalosporins that were tested — ceftriaxone, cefotaxime, and ceftazidime.
(Note: All three of these antimicrobials are recommended as part of the primary or secondary susceptibility panels for Enterobacteriaceae)
Klebsiella species and Escherichia coli that meet the CRE definition are a priority for detection and containment in all settings; however, other Enterobacteriaceae (e.g., Enterobacter species) might also be important in some regions.
For bacteria that have intrinsic imipenem nonsusceptibility (i.e., Morganella morganii, Proteus spp., Providencia spp.), requiring nonsusceptibility to carbapenems other than imipenem as part of the definition might increase specificity.
* This CRE surveillance definition is based upon the current (M100-S22 2012) Clinical and Laboratory Standards Institute (CLSI) interpretative criteria (breakpoints) for carbapenem susceptibility among Enterobacteriaceae (Appendix A); if the older CLSI breakpoints (pre-dating M100-S20 U) are being used to determine carbapenem susceptibility, consideration should be given to including ertapenem in the CRE definition to increase sensitivity.
South Dakota CRE Workgroup
- New Protocol Offers Hospitals Option to Detect Bacterial Contamination of Duodenoscopes
- 2013 Bugs and Drugs Carbapenem-Resistant Enterobacteriaceae and Antimicrobial Stewardship Symposium presentations
- 2012 CRE Toolkit - Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CDC)
- Making Health Care Safer: Stop Infections from Lethal CRE Germs Now — CDC Vital Signs, March 2013
- Carbapenem-resistant Enterobacteriaceae Control and Prevention Toolkit - Agency for Healthcare Research and Quality