Intrapatient transfer of an uncommon carbapenemase in Nebraska

Phenotypic determination of carbapenemase production for CRE was performed using the modified carbapenem inactivation method (mCIM) as described by the Clinical and Laboratory Standards Institute (CLSI).7 According to the Nebraska Department of Health and Human Services protocol, carbapenem-resistant isolates were sent to the Nebraska Public Health Laboratory for genotypic determination of carbapenemase production using Xpert Carba-R (Cepheid, Sunnyvale, CA). Laboratory tests revealed a normal white blood cell count of 11.8 103/mm3; elevated creatinine at 2.61 mg/dL (baseline 2.0 mg/dL); C-reactive protein (CRP) of 137 mg/L; erythrocyte sedimentation rate (ESR) > 120 mm/hour. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/organisms/cre/cre-facilities.html.