Health Advisory

Carbapenem-resistant Enterobacteriaceae

To:      Vermont Healthcare Providers, Vermont Clinical Laboratories
From: Patsy Tassler Kelso, PhD, State Epidemiologist for Infectious Disease
Date:   July 12, 2011

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Carbapenem (imipenem, meropenem, ertapenem, doripenem)-resistant Enterobacteriaceae (CRE), a group of organisms resistant to almost all antimicrobial agents, is emerging as an important challenge in health care settings. Klebsiella is the most commonly implicated species of Enterobacteriaceae.

CRE infections are associated with high rates of morbidity and mortality, and may be more commonly found in people: (1) with prolonged hospitalizations; (2) who have underlying co-morbidities (e.g. immune suppression); (3) who are exposed to invasive devices (e.g. catheters, central lines). CRE infections are also associated with increased length of stay and increased costs.

Vermont Experience

Eight acute care facilities that responded to a recent Vermont Department of Health survey on CRE agree that CRE is an epidemiologically important multidrug-resistant organism for which infection control practices are indicated to eliminate transmission.

In the past 12 months, two of these facilities reported having a CRE-infected or colonized patient present in their facility.

Actions Requested

Acute care facilities should review CDC/HICPAC recommendations and implement appropriate strategies to limit spread of CRE http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5810a4.htm

Surveillance

If CRE or carbapenemase-producing Klebsiella spp. or E. coli are detected, consider investigating possible transmission:

Clinical Microbiology Laboratory

Infection Prevention and Control

Report findings to the Vermont Department of Health

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