MDRO watch
Carbapenem resistant organism tracking that starts the day the isolate is finalized
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.
Try the builder on the sample data, or drop in your own CSV. It is parsed in your browser and never uploaded.
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
Where carbapenem resistance concentrates
Carbapenem resistance is not spread evenly. Long-term acute care hospitals, which take ventilator-dependent and long-stay patients from ICUs, carry far more of it than short-stay hospitals: a Clinical Infectious Diseases study of 64 US LTACHs found 24.6 percent of Klebsiella pneumoniae cultures were carbapenem resistant. Patients then move back and forth between those facilities, nursing homes and the referring hospital, so a rise in one shows up in the others.
If you run or supply one of those facilities, the LTACH antibiogram software page covers building a long-term acute care hospital antibiogram with CRE threshold alerts, and the nursing home antibiogram page covers the skilled nursing side.
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.
Building that intensive care report properly, with the unit filter applied before the first-isolate rule, is covered on ICU antibiogram software.
Related reading: Sensititre antibiogram software, the infection prevention side of the same data, comparing facilities across a network, LTACH antibiogram software, best MDRO surveillance software. 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 summarizes 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
- UTI antibiotic resistance Urine is the highest volume specimen most laboratories process, which makes it the one sourc...
- empiric therapy Every empiric decision is a bet placed before the culture is back. The only honest way to im...
- resistance map Public resistance maps are useful for policy and useless for prescribing. The map that chang...
- nursing home antibiogram A 120-bed skilled nursing facility does not send 30 Escherichia coli isolates a year to its...
- antibiotic stewardship program A stewardship program lives or dies on whether it can answer questions quickly. Most of the...
- CLSI breakpoints A breakpoint revision can move a susceptibility rate by several points without one organism...
Start with your own export
See your own resistance picture, cut the way you actually work
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