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Volume 21, Number 9—September 2015
THEME ISSUE
Emerging Infections Program

Improved Phenotype-Based Definition for Identifying Carbapenemase Producers among Carbapenem-Resistant Enterobacteriaceae

Nora Chea, Sandra N. Bulens, Thiphasone Kongphet-Tran, Ruth Lynfield, Kristin Shaw, Paula Snippes Vagnone, Marion Kainer, Daniel Muleta, Lucy Wilson, Elisabeth Vaeth, Ghinwa Dumyati, Cathleen Concannon, Erin C. Phipps, Karissa Culbreath, Sarah J. Janelle, Wendy Bamberg, Alice Y. Guh, Brandi M. Limbago, and Alexander J. KallenComments to Author 
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (N. Chea, S.N. Bulens, T. Kongphet-Tran, A.Y. Guh, B. Limbago, A.J. Kallen); Minnesota Department of Health, St. Paul, Minnesota, USA (R. Lynfield, K.M. Shaw, P. Snippes Vagnone); Tennessee Department of Health, Nashville, Tennessee, USA (M.A Kainer, D.B. Muleta); Maryland Emerging Infections Program, Baltimore, Maryland, USA (L. Wilson, E. Vaeth); New York–Rochester Emerging Infections Program, Rochester, New York, USA (G. Dumyati, C. Concannon); University of Rochester Medical Center, Rochester (G. Dumyati, C. Concannon); University of New Mexico, Albuquerque, New Mexico, USA (E.C. Phipps, K. Culbreath); Colorado Department of Public Health and Environment, Denver, Colorado, USA (S.J. Janelle, W.M. Bamberg)

Main Article

Table 1

Summary of 11 phenotype-based definitions evaluated for reliability in identifying carbapenemase producers among carbapenem-resistant Enterobacteriaceae, United States, January 1, 2011–January 30, 2014*

Antimicrobial included Study inclusion criteria Definition†
1 2 3 4 5 6 7 8 9 10 11
Any carbapenem‡ NS R R R NS§ R
Any carbapenem (without ertapenem) NS NS NS R NS
>2 carbapenems‡ NS§
All third-generation cephalosporins tested R R
Any third-generation cephalosporins tested R R
Cefepime R R R

*NS, nonsusceptible; R, resistant. Blank cells mean not included in the definition.
†Interpretation based on Clinical and Laboratory Standards Institute breakpoints (M100-S23) (11). Definitions: 1, nonsusceptible to any carbapenem, excluding ertapenem; 2, nonsusceptible to any carbapenem, excluding ertapenem, and resistant to all third-generation cephalosporins tested (pre-2015 Centers for Disease Control and Prevention carbapenem-resistant Enterobacteriaceae surveillance definition); 3, nonsusceptible to any carbapenem, excluding ertapenem, and resistant to any third-generation cephalosporins tested; 4, resistant to any carbapenem; 5, resistant to any carbapenem, excluding ertapenem; 6, resistant to any carbapenem and resistant to all third-generation cephalosporins tested; 7, resistant to any carbapenem and resistant to any third-generation cephalosporin tested; 8, nonsusceptible to at least 2 carbapenems (ertapenem resistant, if tested); 9, nonsusceptible to any carbapenem (ertapenem resistant, if tested) and resistant to cefepime; 10, resistant to any carbapenem and resistant to cefepime; and 11, nonsusceptible to any carbapenem, excluding ertapenem, and resistant to cefepime.
‡Ertapenem, doripenem, imipenem, and meropenem.
§If ertapenem used in the definition, isolate would need to be resistant (i.e., MIC >2 μg/mL).

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Page created: August 12, 2015
Page updated: August 12, 2015
Page reviewed: August 12, 2015
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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