ARLN Utah

CRE/CRPAs

Isolates sent in to UPHL, from participating that are resistant to meropenem, doripenem, ertapenem and/or imipenem are tested for:

• Phenotypic detection via mCIM
• Gene specific testing by PCR for kpc, ndm, imp, vim, and oxa-48
• Antimicrobial Susceptibility Testing (AST) performed on a broad panel of antibiotics using broth microdilution testing method

Whole Genome Sequencing (WGS) is utilized for suspect novel and emerging carbapenemase detection.
Suspect novel and emerging carbapenemase detection are defined as

• Phenotypically Detected as a Carbapenemase Producer (mCIM positive)
• PCR negative for kpc, ndm, imp, vim and oxa-48

For suspect novel/emerging carbapenemase please notify UT ARLN at arlnutah@utah.gov. For additional information please refer to CDC Testing Guidance for CRE and CRPAs opens in a new tab

CRAB

Isolates sent in to UPHL from participating facilities, that are resistant to meropenem, doripenem, ertapenem and/or imipenem are tested for carbapenemase production using Whole Genome Sequencing. For additional information, please refer to CDC's Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE)

Candida auris is an emerging multidrug-resistant fungal pathogen that can be easily misidentified by conventional mycology methods. UPHL offers

• Candida auris rule out identification via MALDI-TOF
• Fungal Antimicrobial Drug Susceptibility Testing
• Free of charge C. auris colonization screening for facilities via PCR and culture-based methods

(see below)

For current C. auris needs contact us at ARLNutah@utah.gov

Highly resistant CRE isolates that are MDROs can be tested for new-to-market antibiotics for treatment purposes.

This new technology 3D prints the plates using the Hewlett-Packard D300e Digital Dispenser.

This method tests isolates susceptibility to aztreonam/avibactam, a new to market combination drug that has shown to be effective against metallo-beta-lactamase producing infections. Organisms available for this testing are Enterobacteriaceaethat are

• resistant to ceftazidime/avibactam and the carbapenem antibiotics

and

• produces metallo-beta-lactamase (IE-NDM, IMP, VIM)

Pre-authrization is required for isolate testing, found here AR Expanded AST Authorization Request Form opens in a new tab
For current ExAST needs contact us at ARLNutah@utah.gov

Colonization screening is performed for CRE/CRPA, CRAB and Candida auris using both culture and PCR based methods. Colonization screening is performed in collaboration with public health officials (state HAI coordinator), healthcare facilities, infection preventionists, and epidemiologists, all of whom can request colonization screening of high-risk patients. Detecting CPO colonization helps prevent transmission within and among facilities. This service is offered to facilities to conduct screening as part of a public health response for the detection of epidemiologically important MDROs.

For any colonization screening needs or questions, please contact UPHL at ARLNutah@utah.gov

Resources

• Colonization Screening Guidance For Carbapenemase Producing Organisms opens in a new tab
• Interim Guidance for a Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms(MDROs) opens in a new tab
• ARLN Colonization Screening Fact Sheet opens in a new tab
• Mountain Region: CRE/CRPA Colonization Screening Collection and Shipping Guidance 2023 opens in a new tab
• Mountain Region: CRAB Colonization Screening Collection and Shipping Guidance 2023 opens in a new tab
• Mountain Region:Candida auris Colonization Screening Collection and Guidance 2023 opens in a new tab

Colistin is currently used as a last resort antibiotic for bacterial infections that are resistant to other therapeutics. Resistance to colistin has been shown to be mediated by the mcr gene.

Isolates that have been identified as having an MIC of ≥4 µg/mL for colistin are tested for the presence of mcr by a PCR