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New England HAI Coordinators

Nicole Bryan, Senior Research Analyst at CSTEMeghan Maloney, CTScott Troppy, Surveillance Epidemiologist at MA DPHPatricia Barrett, Antimicrobial Resistance CoordinatorKerri Barton, Epidemiologist at MA DPHBrittany RoyCarly Zimmermann, Antimicrobial Resistance Specialist at NH HDEileen McHale, MA DPHMelissa Cumming, AR Coordinator at MA DPHYvette Perron, NH HAI Surveillance Coordinator lisa tibbitttsMaureen MarsellaEmily CooperChristina BrandeburgKaryn Langguth +8 others
Posted by William Fritch ·

CRE Questions

Hi all! I hope this is an acceptable place to post some rookie HAI-AR questions. I’ve already begun discussing these with Carly in NH, who was kind enough to send me an invite to this basecamp. My questions pertain to CRE definitions and reporting criteria.

I was reviewing our Reportable Laboratory Findings list and a ‘Guidelines for CRE in Vermont’ document that was developed last year (which can be seen in our folder in the Docs & Files portion of this site). I noticed that there seems to be a discrepancy, in that the lab findings document just listed Carbapenem-resistant Enterobacteriaceae (read: all) as reportable, whereas the Guidelines document was specific to E. coli, Klebsiella spp., and Enterobacter spp. 

Can anyone provide me with some information on the significance, or history/rationale for why a set of reporting criteria might be limited to those genera (vs all Enterobacteriaceae)? I see that the 2018 CSTE Position Statement on CP-CRE is also focused in that way.

Thank you!

Will Fritch
HAI Coordinator
Vermont Department of Health

Comments & Events

Scott Troppy, Surveillance Epidemiologist at MA DPH Scott Troppy, Surveillance Epidemiologist at MA DPH
Bill - a perfect place to post a question such as this - let me review my notes and check with a few others on why this is the direction we chose back in 2015.

Scott
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William Fritch William Fritch
Great, thank you, Scott! - Will
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Scott Troppy, Surveillance Epidemiologist at MA DPH Scott Troppy, Surveillance Epidemiologist at MA DPH
Checking in with a few other epi's.... we think because of data contributed by TN that said that these were the most prevalent at the time of the position statement. 

Indiana decided to make all CRE and CP-CRE notifiable because they didn't know if our epidemiology looks like other states’. (and because the CSTE position statement wasn’t out at the time.)
 
When the Message Mapping Giude was worked on back in 2017 - the group went with one condition code (MDRO) it was said that because creating condition codes for all the Enterobacteriaceae would be too cumbersome for implementation that they wanted to focus on the most common genera. So, we can capture most of the CRE/CP-CRE without having to do all of the back end work in creating around 70 new condition codes.

Each state does something a little different as you know. The national notification of CP-CRE was adopted last year at CSTE conference. We are working on the guide to report but at the end of the day each state can decide which path they want to go down with reportables.

Does that help? Scott
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William Fritch William Fritch
It certainly does help, thank you! Being a low incidence state, I think it's going to make sense for us in VT to keep things more broad, at least for the time being. I think we'll be looking to update our "Guidelines for CRE in Vermont" document to reflect that. We wouldn't want facilities not to report carbapenem-resistant Serratia or Citrobacter. 

The other point I'm reviewing from our current Guidelines document relates to the CP-CRE vs non-CP-CRE distinction and how we respond to each. All CRE (CP and non-CP) are currently reportable in Vermont, and again, given our low incidence, this seems to make sense for us. However, our Guidelines document says that all close contacts and roommates should have rectal swabs collected for surveillance, and I'm having some facilities question that in the context of seemingly sporadic non-CP-CRE. CDC's Facility Guidance document (Nov. 2015 Update) seems to allow for some flexibility, and mentions the ability to "tailor the range of interventions they apply" [based on local epi data]. Do you, Scott, or anyone else reading this thread, feel like sharing your experiences in working with facilities to decide on the appropriate level of intervention, particularly in the context of non-CP-CRE?

- Will
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Melissa Cumming, AR Coordinator at MA DPH Melissa Cumming, AR Coordinator
Hi Will,
We do not do contact screening for non-CP CREs. An exception might be if there were a cluster associated with a device like a scope or something like that.

This is outlined in our CRE Toolkit which was adapted from Oregon’s and can be found at the bottom of this page:
https://www.mass.gov/service-details/carbapenem-resistant-enterobacteriaceae-cre-information-for-providers


Melissa


____________________________________________
Melissa A. Cumming M.S.
Epidemiologist
Antibiotic Resistance and Hemovigilance Coordinator
Epidemiology Program
Bureau of Infectious Disease and Laboratory Sciences
Massachusetts Department of Public Health
305 South Street
Jamaica Plain, MA 02130
(Tu, Th, Fri) State Lab 617-983-6817
(M, W) West Boylston Office 508-792-7880 ext. 2345
melissa.cumming@state.ma.us<mailto:melissa.cumming@state.ma.us>
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William Fritch William Fritch
Hi Melissa,

This is exactly the sort of resource I was looking for! I appreciate you sharing it.

- Will
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