Carbapenem-resistant Enterobacterales (all genera)

Reportable by Laboratories and Providers

About this Reportable Disease

Infectious agent:  Enterobacterales is an order comprised of gram-negative rod facultative anaerobes.

Description of illness: Enterobacterales cause a wide range of clinical infections and are a major cause of nosocomial infections. CRE include any organism that falls under the Enterobacterales order that are non-susceptible to carbapenem antibiotics and can cause infections with high rates of morbidity and mortality, particularly among persons with prolonged hospitalization, those who are critically ill, and those exposed to invasive devices (e.g., ventilators or central venous catheters). Symptoms may manifest thru respiratory, wound, urinary tract, invasive, tissue, and other infections.  Some CRE have shown to be resistant to all or nearly all available antibiotics and therefore are classified by the Centers for Disease Control and Prevention (CDC) as an urgent threat.

Interactive Disease Data


Laboratory Reporting for this Disease

Enterobacterales, Carbapenem Resistant 

TEST NAME

Enterobacterales - Carbapenem Resistant
DISEASE/DISORDER Carbapenem Resistant Enterobacterales 
ALTERNATE NAME(S) CRE 
METHODOLOGY MALDI-TOF,  PCR,  Antibiotic susceptibility testing, mCIM 
SPECIAL INSTRUCTIONS
  • Isolate submission REQUIRED 
  • Include susceptibility test results, if available
ORDERING INFORMATION TDOH ARLN Lab Web Portal

Specimen Requirements

Patient Preparation
  • None
Specimen Collection
  • For laboratories able to test for carbapenemase production or carbapenemase-producing genes, report any organism with either of the following:

-Detection of carbapenemase production

-Detection of at least one carbapenemase-producing gene

  • If detected via NAAT, perform culture to obtain an isolate for subsequent testing to determine the antibiotic susceptibility profile
  • For laboratories unable to test for carbapenemase production or carbapenemase-producing genes, report these organisms and resistance scenarios:

-Enterobacterales order: Proteus species, Providencia species, and   Morganella morganii with intermediate or resistant interpretations to   ertapenem, meropenem, or doripenem

  • All other Enterobacterales bacteria with resistant interpretation to at least one carbapenem antibiotic
Specimen Labeling
  • Specimen must be labeled with at least two unique patient identifiers and match the accompanying TNDOH ARLN Lab Web Portal.
Specimen Processing
  • None
Specimen Storage and Preservation
  • Store specimens at ambient temperature until shipment.
Specimen Transportation
  • Ship specimens at ambient temperature.
  • All infectious substance shipments must conform to U.S. Department of Transportation (DOT) Hazardous Materials Regulations (HMR 49 C.F.R. Parts 171-180). 
Specimen Acceptability and Rejection
  • Only pure cultures will be accepted for testing. 
  • Mixed cultures will be rejected.
  • Specimens that are mislabeled will be rejected.
  • Specimens that are broken in transit will be rejected.
  • Specimens received that do not meet the specimen requirements outlined in the Directory of Services or that deviate from the special instructions will not be acceptable for testing.
Testing Location
  • Nashville

Laboratory Reporting

Reporting requirements apply to all laboratories located within Tennessee, as well as laboratories outside of Tennessee that test residents of Tennessee, including laboratories located within healthcare facilities. Healthcare providers and laboratories in the same healthcare facility both have a duty to report. The type of organisms and analytes laboratories must report to TDH for 2026 are indicated, and there are several ways laboratories can report results to TDH.

 

Information about this Reportable Disease for Healthcare Providers

Clinical Summary

  • Carbapenem-resistant Enterobacterales (CRE) are Enterobacterales bacteria (all genera) that are non-susceptible to carbapenem antibiotics and can cause infections with high morbidity and mortality, particularly in patients with prolonged hospitalization, critical illness, or exposure to invasive devices (e.g., ventilators, central venous catheters).
  • CRE can present as respiratory, wound, urinary tract, invasive/sterile-site, tissue, and other infections, and they can also colonize patients (carriage without active infection), which usually does not require treatment but is important for infection control.
  • CRE spread most often in healthcare settings (hospitals, long-term care), can cause outbreaks, and can move between facilities as patients transfer—so early identification and facility-to-facility communication matter. CDC recommends ensuring the clinical lab can identify CRE and immediately alert clinical and infection prevention staff, and following public health guidance for detection, tracking, and reporting.
  • In Tennessee, CRE (Enterobacterales, carbapenem-resistant—all genera) is a reportable condition; prompt reporting supports public health response and containment in healthcare facilities.

Healthcare Provider Reporting

Healthcare reporting requirements apply to all providers located within Tennessee, as well as providers whose patients reside in Tennessee.

Providers must report cases of all diseases and conditions listed through one of these methods:

• Mail or fax a completed PH-1600 form to your local health department or fax to the state health office at (615) 741-3857

• Send automatically via electronic case reporting (eCR). See this TDH webpage for more information on eCR, register at the Trader Partner Registration website, or contact MU.Health@tn.gov for assistance.

• Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting. 

• Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link. 

Information about this Reportable Disease for the Public

What CRE Are

Carbapenem-resistant Enterobacterales (CRE) are a group of bacteria that have become resistant to “carbapenem” antibiotics, which are often used as a last-resort treatment for serious infections. Enterobacterales normally live in the intestines, but they can cause illness if they get into places like the bladder, lungs, or bloodstream. 

Why CRE Are a Public Health Concern

CRE infections can be difficult—and sometimes extremely difficult—to treat because treatment options may be limited. CDC considers CRE a serious threat to patient safety and notes that these infections can lead to severe illness and death. 

How CRE Spread

CRE most often spread in healthcare settings (such as hospitals and long-term care facilities). They can move from one facility to another as patients transfer between locations, which is why prevention and coordination across healthcare settings matters. 

Who Is at Higher Risk

People who receive medical care in healthcare facilities—especially those with devices or complex medical needs—are at higher risk of CRE infection. In general, CRE is more likely to affect patients with significant healthcare exposures.

How CRE Infections Are Prevented

CDC emphasizes infection prevention steps in healthcare settings to reduce CRE spread, including identifying cases promptly and following recommended infection control practices to protect patients and prevent outbreaks. 

This Page Last Updated: March 25, 2026 at 8:53 PM