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Carbapenem-Resistant Enterobacteriaceae (CRE)


Note: As of July 1, 2015, the the carbapenem requirements for the laboratory surveillance definition of CRE and the case definition changed. For more information see

Changes in definitions (disease control) 333-017-000 (pdf)

Changes in reporting (disease reporting) 333-018-000 (pdf)

The Enterobacteriaceae are a large family of Gram-negative bacilli, many members of which are upstanding residents of the human gastrointestinal tract. See the full list of genera (pdf). Currently available carbapenem antibiotics, commonly used to treat severe, hospital-associated infections caused by Gram-negative bacteria, are doripenem, ertapenem, imipenem, and meropenem. Carbapenem resistance in Enterobacteriaceae can occur by many mechanisms, including the production of Klebsiella pneumoniae carbapenemase (KPC) or a metallo-beta-lactamase.

In the U.S., CRE were first reported in North Carolina in 1999; since then, they have been reported in at least 32 states. Unfortunately, carbapenem resistance genes can be transmitted among bacteria of different genera, so that once CRE emerge in a given area, the carbapenem antibiotics may lose their effectiveness against many different organisms. If CRE become prevalent, empiric therapy will necessitate antibiotics that have broader antibacterial spectra and are much more expensive; and some patients may die for lack of prompt and effective treatment. If we can rapidly identify and isolate patients with CRE we may be able to prevent or delay their becoming endemic in Oregon.

Disease Reporting

What is required?
Health care providers and clinical laboratories are required by law to report cases and suspect cases to local health departments within one working day. 

Disease reporting form (pdf) for health-care practitioners

Go to our disease reporting page for information on how to report and for telephone numbers of local health departments.

View the CRE Reporting Poster (pdf)

Clinical laboratories are asked to save novel CRE isolates (i.e., not more than one per patient of the same genus and species per calendar year). These isolates should be forwarded to the Oregon State Public Health Laboratory, with the following exceptions:  Proteus spp., Providencia spp., and Morganella  spp. should not be saved or sent to OSPHL. 

For county health departments

Investigative Guidelines: Carbapenem-resistant Enterobacteriaceae (pdf)



See Also