Heather Dubendris

by Heather Dubendris, MSPH

Enterobacteriaceae are a normal part of gut bacteria. Carbapenem-resistant Enterobacteriaceae (CRE) are bacteria that are resistant to nearly all antibiotics and cause over 9,000 healthcare-associated infections each year. The mechanism of resistance among CRE currently of greatest public health concern is production of Carbapenemase enzymes. CRE producing carbapenamases are known as Carbapenemase producing CRE or CP CRE. Beginning March 1, 2015, NC DPH implemented a sentinel surveillance system to characterize CRE infections and colonization among patients admitted to seven of the state’s largest medical centers and to assess the prevalence of specific mechanisms of resistance.

As of March 31, 2016, 212 cases have been identified; 118 (56%) of which were identified through surveillance cultures. The most common infections were urinary tract (n=31, 33%), bacteremia (N=16, 17%), and pneumonia (n=13, 14%). Among patients from whom CRE were isolated, the median age was 56 years, and half were female (54%).

The majority of patients had recent healthcare exposures including hospitalizations, indwelling devices and a recent history of antibiotics. We identified the predominance of CRE isolates (n=110, 52%) to be carbapenamase-producing. These results will be used for future antimicrobial resistance prevention activities and program planning as we consider incorporating CRE as a reportable condition in NC.

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