Carbapenemase Producing - Carbapenem Resistant Enterobacteriaceae

No cost for this testing.

1. Organisms: Enterobacterales isolates that are resistant to at least one carbapenem that have not undergone carbapenemase testing, OR isolates that have screened positive for a carbapenemase using a phenotypic testing method* (mCIM, CarbaNP), OR isolates that test positive for a carbapenemase gene using molecular methods** (KPC, NDM, VIM, IMP, OXA-48). Isolates do not need to be sent if less than one (1) calendar year has passed since the last identical (same organism and same mechanism) isolate was sent for the patient. Exception: Proteus spp., Providencia spp., and Morganella morganii that are resistant to imipenem only but are not resistant to meropenem or doripenem as these isolates may have elevated imipenem MICs by mechanisms other than production of carbapenemases.
   • Isolates that are negative via Modified Hodge test should be submitted for additional testing.
   • Carbapenem resistant isolates tested by Cepheid testing only should be submitted if no carbapenemase genes were detected due to the limitation of the Cepheid assay.
2. Specimen type: Isolates
   Isolate should be pure, viable, and cultured onto an organism-appropriate agar medium slant.
3. Only one (1) isolate per patient will be tested.
4. Isolates should be submitted within three (3) business days of isolation per the IDOH Communicable Disease Rule 410-IAC 1-2.3-76.

1. Sample Container: appropriate agar medium slant in a tube with the screwcap tightened or other similarly-approved commercial transport medium.
2. Shipping boxes/containers with appropriate shipping labels commercially available.

1. Properly label each specimen tube with a minimum of the patient’s name, date of birth, and isolation date.
2. A minimum of two unique patient identifiers (i.e. first/last name, DOB, MRN) must be indicated on the isolate tube. Unique identifiers must match what is entered in to LimsNet
3. Check the expiration date on the tube. Ensure the product is acceptable and will be acceptable upon receipt at the IDOH Laboratory.
4. Complete LimsNet submission form for CRE testing. LimsNet is available at http://limsnet.isdh.in.gov. Users should call the LimsNet Help Desk for system access at 888-535-0011 or locally at 317-921-5506. Submitters may email the help desk at LimsAppsupport@health.in.gov.

For case consultation, contact IDOH Epidemiology at 317-233-1306.

Ship to:

Indiana Department of Health - Laboratory
Suite B, ARLN Microbiology
550 West 16th Street
Indianapolis, IN 46202

1. Package according to Category B UN3373 triple contained in accordance with federal shipping regulations for infectious substances/diagnostic specimens.
2. Tighten the specimen container tube caps.
3. Label clearly on each specimen tube with the patient name, date of birth, and isolation date.
4. Wrap each labeled, container/tube with absorbent material. Place absorbent material into the inner mailing container of each primary tube and tighten the cap securely.
5. The completed submission form may then be wrapped around the sealed inner container and together placed securely into the outer shipping container.
6. Clearly label the outer container with the sender's name/address and recipient's name/address.
7. Do not send culture isolates on petri plates if submitting by mail.
8. Transport Temperature:  ambient conditions.

Reporting Method:  LimsNet

TAT (IDOH Testing): 3-5 business days.

Test Referral: Isolates may be forwarded to the CDC or a Reference Laboratory for additional testing. Projected TAT listed above does not account for time required for isolate submission to the CDC.