Guidance for Control of Infections with Carbapenem-Resistant or
Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities
For all acute care facilities, CDC and HICPAC recommend an aggressive
infection control strategy, including managing all patients with CRE using
contact precautions and implementing Clinical and Laboratory Standards
Institute (CLSI) guidelines for detection of carbapenemase production.
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CDC: New Guidance for Carbapenem-Resistant Bugs, Medical News
Earlier this year, the Clinical and Laboratory Standards Institute recommended
that susceptible Enterobacteriaceae with elevated MICs or reduced disk diffusion
zone sizes be tested for the presence of carbapenemase enzymes using the
modified Hodge test. Clinical microbiology laboratories should follow Clinical and
Laboratory Standards Institute guidelines for susceptibility testing and establish
a protocol to detect carbapenemase enzymes, using, for instance, the modified
Hodge test.
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Guidance for Control of Infections With Carbapenem-Resistant or
Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities
A difficulty in detecting CRE is the fact that some strains that harbor bla^kpc
have minimal inhibitory concentrations (MICs) that are elevated but still
within the susceptible range for carbapenems. Because these strains are susceptible
to carbapenems, they are not identified as potential clinical or infection control risks
using current susceptibility testing guidelines. To address this challenge, in January 2009,
CLSI published a recommendation that carbapenem-susceptible Enterobacteriaceae
with elevated MICs or reduced disk diffusion zone sizes be tested for the presence of
carbapenemases using the modified Hodge test (MHT).
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CLSI standards for antimicrobial susceptibility testing include:
M02-A10 - Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard - Tenth Edition
M07-A8 - Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved Standard - Eighth Edition
M100-S19 - Performance Standards for Antimicrobial Susceptibility Testing; Nineteenth Informational Supplement