Carbapenem-Resistant Enterobacterales (CRE) Reporting

CRE Investigation Guidance

Report a suspected or confirmed case within 1 work day to your local health department.

Clinical Case Definition

When found in a clinical culture, CRE can represent an infection or colonization. There is no set clinical case definition for a CRE as it can cause many types of symptoms.

Laboratory Confirmation

A Klebsiella species or E. coli from any body site that is laboratory confirmed:

  • Klebsiella species or E. coli resistant to any carbapenem, including meropenem, imipenem, doripenem, or ertapenem, OR
  • Production of a carbapenemase (i.e. KPC, NDM, VIM, IMP, OXA-48) demonstrated by a recognized test (i.e. polymerase chain reaction, metallo-β-lactamase test (e.g., E-test) positive, modified Hodge test, Carba NP), OR
  • Modified Carbapenem Inactivation Method (mCIM) positive or indeterminate, OR
  • Carbapenem Inactivation Method (CIM) positive, OR
  • Modified Hodge Test (MHT) positive

Case Classification

Confirmed: Carbapenem-resistant Enterobacterales (CRE):

  • Klebsiella species, or E. coli from any body site that is laboratory confirmed.

Note: It is not possible to determine which organism the carbapenemase gene belongs to if a culture-independent diagnostic test (CIDT) reports multiple pathogens detected AND a carbapenemase gene detected is received. In this case, the recommendation is to collect a culture from the same site.

CRE Investigation Form (PDF)

When reporting CRE, please include (if available):

  • a copy of the lab report
  • carbapenems tested
  • susceptibility of antibiotics
  • minimum inhibitory concentration (MIC)
  • positive phenotypic or PCR test, if applicable.

*A DSHS or local health department epidemiologist may contact you for follow-up after receiving your report.