MDRO watch
Carbapenem resistant organism tracking that starts the day the isolate is finalised
Carbapenem resistance is the event that changes what a hospital can do next, and it is the last thing that should be discovered in an annual report.
Short answer
A carbapenem resistant organism is an isolate that is no longer susceptible to at least one carbapenem, most often an Enterobacterales species, Pseudomonas aeruginosa or Acinetobacter baumannii. Tracking it means watching a small count move rather than reading a percentage once a year, which is a different reporting problem from the cumulative antibiogram.
Small numbers need counts, not percentages
Most facilities have few carbapenem resistant isolates, and that is exactly why the annual antibiogram handles them badly. A cell with eight isolates is suppressed under the 30-isolate rule, correctly, because a percentage on eight isolates is noise. But the eight isolates themselves are the signal.
The two reports answer different questions. The cumulative antibiogram answers what to start empirically. MDRO tracking answers whether something is happening that infection prevention should look at this week. The same export feeds both.
What the watch list normally contains
The organisms below are the ones most stewardship and infection prevention programs follow, because each removes a class of options and each has an established infection control response.
- Carbapenem-resistant Enterobacterales, usually Klebsiella pneumoniae, Escherichia coli or Enterobacter cloacae
- Carbapenem-resistant Pseudomonas aeruginosa
- Carbapenem-resistant Acinetobacter baumannii
- Extended-spectrum beta-lactamase producers, as a phenotype from the third generation cephalosporin result
- Methicillin-resistant Staphylococcus aureus, from the oxacillin or cefoxitin result
- Vancomycin-resistant Enterococcus
Meropenem is the column to watch, and it is usually the thinnest one
In the sample dataset on the homepage the meropenem column is suppressed on every organism, because a carbapenem is a restricted agent: it is added on request rather than run on the routine card, so a year of isolates yields fewer than thirty results. That is not a gap in the report, it is the report telling you the truth, and it is why the fluoroquinolone columns beside it, which are tested on everything, are the ones whose quarterly slide you can actually read.
Set the unit filter to the intensive care unit and the picture changes: the same organisms are less susceptible across almost every column, which is why a facility-wide figure is a poor guide for an intensive care prescriber.
Related reading: the infection prevention side of the same data, comparing facilities across a network. The four steps from susceptibility testing data to an antibiogram cover the method end to end.
Questions
On this page's topic
Is this an alerting system for infection prevention?
No. Antimicrobe summarises the susceptibility data you provide, on your schedule. It does not receive a live feed and it does not page anyone. Threshold flags on the Stewardship plan and above mark movement in a report, not in real time.
Do you identify carbapenemase genes?
No. Genotype comes from molecular testing, not from a susceptibility export. What the export supports is the phenotype, which is what a cumulative report is built from.
Why is my carbapenem cell suppressed?
Because it holds fewer than 30 isolates under your current filters. Widen the period or turn the suppression rule off to see the underlying count, which is shown on the tile either way.
More on antimicrobial resistance reporting
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- CLSI breakpoints A breakpoint revision can move a susceptibility rate by several points without one organism...
- WHONET WHONET is good software, it is free, and it is the global default for a reason. This page is...
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