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IMPORTANT! Pre-approval needed from state or local health department. Local or State Health Department. Send approval to NPHL@unmc.edu or call (402) 559-9444.
NPHL has moved to an electronic ordering system, NUlirt, and it is now the preferred method to order all tests. Once ordered, print a "batch list" (see NUlirt Guide).
Forms Required - Nulirt batch list or NPHL Test Request Form (completed in entirety) must accompany the specimen to include the following information: symptoms and date of onset, pregnancy status, travel and vaccine history. Testing will not be performed without all required information.
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| Test: |
Carbapenemase Molecular Detection
Order in NUlirt or complete NPHL Test Order Form with
Supplemental Form: http://nphl.org/documents/NPHL CRE_CPE Supplemental Form110518.pdf
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| Synonym: |
CARBAR, KPC Detection, CRE, CPE
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| Method: |
Cepheid Xpert Carba-R
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| Availability: |
Test performed Monday-Friday
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| Specimen: |
Resistance to imipenem, doripenem, ertapenem or meropenem as defined by the CDC. Carbapenem-resistant Enterobacterales (CRE) (excluding Proteus species, Providencia species, or Morganella morganii) are reportable to the Nebraska Department of Health and Human Services via electronic lab report, phone or fax within 24 hours.
Additionally, laboratories unable to perform phenotypic or molecular testing to confirm carbapenemase production in these organisms should send suspected CRE isolates that meet the criteria below to NPHL. Labs that are able to do such testing should only send isolates positive for carbapenemases to NPHL. Ship as Category B, Biological Substance UN3373. Guidelines for submission are below:
1. Submit all isolates of Enterobacterales that are resistant to any of the carbapenems. Exceptions are Enterobacter cloacae and E. aerogenes: only submit isolates that are resistant to carbapenems other than ertapenem. Do not submit Enterobacterales with known intrinsic resistance to carbapenems; i.e. Proteus species, Providencia species, and Morganella morganii.
2. Submit all isolates of in-house or reference laboratory confirmed carbapenemase-producing Enterobacterales (CPE).
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| Collection Device: |
Isolate area on media slant or plate, sealed with Parafilm™ or tape.
Specimen Labeling: Test subject to CLIA regulations and required 2 patient identifiers on specimen container and requisition forms
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| Volume: |
One agar plate or slant
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| Storage/Transport: |
Prior to shipment: Ambient air 15-25°C
Shipping instructions, including specimen-handling requirements during transport: Seal screw-top tubes with Parafilm™ or tape and place in biohazard bag with absorbent material.
Place packing list or other paperwork on top of Styrofoam and lid. Mark out rigid box as UN3373 Category B, Biological Substance. Transport by NPHL ground courier. If courier not available, ship by FedEx, UPS or USPS (1st Class, Priority or Express Mail). Follow appropriate DOT/IATA Regulation Guidelines. For assistance, call NPHL State Training Coordinator at (402) 559-3590.
See instructions and shipping address: http://nphl.org/
NUlirt packing list or appropriate paperwork (completed in entirety) must accompany specimens.
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| Unacceptable: |
Organisms that do not meet the requirements outlined on the supplemental requisition or submitted without the supplemental requisition
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| Specimen Stability: |
Stable at ambient temperatures
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| Reference Interval: |
Not detected
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| Reportable Disease: |
All carbapenemase-resistant Enterobacterales will be reported immediately to local or state health department.
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| Comments: |
Testing results are to be used for epidemiological and infection control purposes only.
The confirmation of a carbapenemase-resistant Enterobacterales needs to be reported immediately to the in-house infection control official. Additional CPE colonization testing will need to be considered in consultation with epidemiologists.
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| Revised: |
9/9/2022 |
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If you have questions about proper specimen collection, please call NPHL Client Services at (402) 559-2440 or toll free at (866) 290-1406.
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