| Synonym(s): | Carbapenem Resistant Enterobacterales, Carbapenem Resistant Pseudomonas aeruginosa, Carbapenem Resistant Acinetobacter baumanii, CRE, CRPA, CRAB, CRO, ARLN, Carbapenem, Antimicrobial resistance, Antimicrobial Susceptibility Test, PCR, Antimicrobial, MALDI-TOF, mCIM, Broth Micro Dilution |
|---|
| Requisition Form | G-2E |
|---|
| Test Description | Definitive identification of CRO isolates by MALDI-TOF, antimicrobial susceptibility determined by broth micro dilution, and carbapenemase production determination by real-time PCR. |
|---|
| Pre-Approval Needed | N/A |
|---|
| Supplemental Information Required | - Antimicrobial susceptibility report from submitter
- Copies of any previous Lab tests (carbapenemase production or PCR), if available.
|
|---|
| Supplemental Form(s) | N/A |
|---|
| Performed on Specimens from (sources) | Human |
|---|
| Sample/Specimen Type for Testing | - Pure-cultured CRO isolate from any type of clinical specimen grown on a non-inhibitory, non-selective agar plate or/slant or broth.
- Pure-cultured CRE isolates resistant to any imipenem, meropenem or ertapenem.
- Pure-cultured CRPA isolates resistant to at least one imipenem, or meropenem AND non-susceptible (intermediate or resistant) to cefepime or ceftazidime.
- CRAB isolates resistant to imipenem, or meropenem.
|
|---|
| Minimum Volume/Size Required | - At least one viable pure isolate per plate or slant.
- Single tube of pure culture isolate.
|
|---|
| Storage/Preservation Prior to Shipping | - Store and ship isolates at ambient temperatures.
- Ensure that growth media used does not expire before specimen collection date.
|
|---|
| Transport Medium | - Isolates should be submitted on a non-inhibitory, non-selective agar plate or/slant or broth.
|
|---|
| Specimen Labeling | - At least two patient identifiers required on specimen (e.g., patient full name, date of birth, medical record number).
- Three patient identifiers are preferred.
- Identifiers on specimen must exactly match identifiers in submission form (e.g. abbreviated name on label and full name on form is not acceptable).
- Additional DSHS Laboratory specimen labeling guidelines available online here.
|
|---|
| Shipping and Specimen Handling Requirements | - Ship according to Dangerous Goods Regulations, IATA, and/or CFR 49
- Category B Biological Substance, UN3373 shipping requirements apply
- Submitters are responsible for packaging and shipping specimens according to regulatory requirements.
- Additional DSHS Laboratory submission guidelines available online here.
|
|---|
| Method | - Identification of CRE, CRPA, and CRAB by MALDI-TOF.
- Antimicrobial susceptibility testing by broth micro dilution.
- Carbapenemase production in CRE and CRPA determined by modified Carbapenem Inactivation Method (mCIM). Carbapenemase producing CRE, CRPA and CRAB identified by real-time PCR.
|
|---|
| Turn-around Time | 7 working days |
|---|
| Interferences/Limitations | - Organisms must be viable for culture studies.
- The results from this test should be used only for epidemiological purposes and not for patient treatment.
|
|---|
| Common Causes for Rejection | - Mixed culture submitted.
- Insufficient specimen growth.
- Antimicrobial susceptibility result not provided by submitter.
- Missing identifiers on specimen and/or submission form.
- Isolate submitted not a target organism.
- Media expired at time of isolate culture.
- Discrepancies between specimen label and submission form
- Incomplete, missing, or illegible submission form.
- Specimen collection guidance available from AR Laboratory, email TexasARLN@dshs.texas.gov or refer to online guidance.
|
|---|
| Additional Information | N/A |
|---|
