Carbapenem-Resistant Organisms (CRO)

Carbapenem-Resistant Organisms/ Carbapenemase-Producing Organisms (CRO/CPO)

Background

Carbapenem‑resistant organisms (CROs) are germs that don’t respond well to important antibiotics. Examples include E. coli, Klebsiella, and Acinetobacter. Carbapenems, such as ertapenem, imipenem, and meropenem, are strong antibiotics used when other medicines no longer work. CROs usually spread through direct contact with an infected person, especially through wounds or stool, in a healthcare setting. If these germs enter the body, they can cause serious infections, often through medical devices like ventilators, IVs, urinary catheters, or wounds from injuries or surgery. Preventing these infections requires following safety rules, using proper cleaning products, and making sure healthcare facility staff follow infection-control practices.

The CDC considers CROs a major health threat in the United States. These germs are grouped into two categories based on whether they make a substance called a carbapenemase. Germs that do produce carbapenemase are known as carbapenemase‑producing organisms (CPOs). Carbapenemases are proteins that break down carbapenem antibiotics, making them useless for treating infections. Even more concerning, these carbapenemases are often carried on mobile genetic elements that can move between germs. This allows resistance to spread quickly from one patient to another.

Public Health Response:

VDH works with healthcare facilities to slow the spread of these dangerous organisms. VDH follows the CDC Guidance for a Public Health Response to Contain Novel or Targeted MDROs. Facilities should collaborate with their local health department on response efforts.

 

 

 

Educational Resources

Request an Assessment

VDH Infection Prevention and Control Assessments: The HAI/AR team is available to conduct a no-cost, non-regulatory, onsite visit to help a facility identify its infection prevention strengths and areas of opportunity.

 

 

 

Setting-Specific Resources

CDC Interfacility Transfer Form - The patient transfer form helps make it easier to share information when patients are moved between different places for care. Hospitals and groups focused on making patient safety better can change and use this form to fit their needs.

Carbapenem-resistant organism resources specific to hospital settings: 

 

 

 

 

 

 

Data & Reporting

Reporting Requirements

Reporting of the following diseases is required by state law (Sections 32.1-36 and 32.1-37 of the Code of Virginia and 12 VAC 5-90-80 of the Board of Health Regulations for Disease Reporting and Control). Report all conditions when suspected or confirmed to your local health department (LHD). Reports may be submitted by Confidential Morbidity Report Portal (Epi-1 form), computer-generated printout, CDC or VDH surveillance form, or upon agreement with VDH, by means of secure electronic submission.

 

 

 

Laboratory Testing

 

 

 

Collaborations

The Health Coordination Network (HCN), started in 2017, connects healthcare facilities like hospitals and nursing homes across the state. HCN now includes alerts for Candida auris and other drug-resistant organisms (MDROs). Since these alerts aren’t updated in real-time and only cover patients known to VDH, facilities should share MDRO status when transferring patients. VDH suggests using the CDC Inter-Facility Infection Control Transfer Form for complete MDRO information. Note: The MDRO flags are an extra tool, not a substitute for direct communication.