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Carbapenemase Confirmation (MCIMAR)  

 
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.

Please call NPHL Client Services at (402) 559-2440 or toll free at (800) 334-0459 for further clarification.

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Test: Carbapenemase Confirmation  
Synonym:
  • Carbapenemase molecular detection
  • CARBAR
  • KPC Detection
  • CRE
  • CPE
  • MCIM
 
Method:
  • Modified carbapenem inactivation method or
  • Cepheid Xpert Carba-R
 
Availability:
  • Test performed Monday-Friday
  • Turnaround time 7 days
 
Specimen:
  • Fresh isolate
  • Submit isolate of Enterobacterales and/or Pseudomonas aeruginosa and/or Acinetobacter baumanii that are non-susceptible (intermediate or resistant) to carbapenems as mentioned below
    • Enterobacterales: Ertapenem MIC >/= 1 µg/mL, or meropenem MIC >/= 2 µg/mL, or imipenem MIC  >/= 2 µg/mL, or non-susceptible by disk diffusion method (see rare exceptions below)
    • Pseudomonas aeruginosa: meropenem or imipeneim MIC >/= 4 µg/mL or non-susceptible by disc diffusion method and in each case also non-susceptible to both cefepime and cefazidime at MIC  >/= 16 µg/mL
    • Acinetobacter baumannii: Doripenem  >/= 4 µg/mL or imipenem  >/= 4 µg/mL or meropenem  >/= 4 µg/mL or non-tsusceptible by disc diffusion method
    • Submit all isolates of in-house or reference laboratory confirmed carbapenemase-producing Enterobacterales (CPE) or Pseudomonas aeruginosa (CP-PA) or Acinetobacter baumannii (CP-CRAB)
  • Exceptions:
    • For identical organisms and suceptibility patterns, repeat testing not performed within 30 days.
    • DO NOT submit the following isolates
      • Proteus species, Providencia species, or Morgenella morganii non-susceptible only to imipenem but susceptible to meropenem and ertapenem
      • Pseudomonas aeruginosa that are mucoid or from cystic fibrosis patients
   
Collection Device:
  • Isolate area on media slant or plate, sealed with Parafilm™ or tape.
   
  • Test subject to CLIA regulations and required 2 patient identifiers on specimen container and requisition forms
 
Volume: One agar plate or slant  
Storage/Transport:
  • For shipping, see Category B instructions
  • https://www.nphl.org/index.cfm/specimen-packaging-shipping/
  • Seal screw-top tubes with Parafilm™ or tape and place in biohazard bag with absorbent material.
  • NUlirt packing list or appropriate paperwork (completed in entirety) must accompany specimens.
 
Unacceptable: Organisms that do not meet the requirements outlined on the supplemental requisition or submitted without the supplemental requisition  
Specimen Stability: Stable at ambient temperatures  
Reference Interval:  
Reportable Disease: All carbapenemase-resistant Enterobacterales will be reported immediately to local or state health department.  
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.
 
Revised: 3/13/2024 
If you have questions about proper specimen collection, please call NPHL Client Services at (402) 559-2440 or toll free at (800) 334-0459.

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