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CDC

Antimicrobial Resistance Lab Network

Carbapenem-Resistant Enterobacterales

Number of CRE Isolates Tested

150,915

2017 – 2024

Percentage of CRE with at least one targeted Carbapenemase Gene Detected

34.67%

52,316 CRE with carbapenemase gene detected / 150,915 CRE isolates tested

Most Common Carbapenemase in CP-CRE

70.49% KPC

36,880 CRE with KPC / 52,316 CP-CRE

AR Lab Network Priority Area

Carbapenem-Resistant Enterobacterales

Collectively, Enterobacterales are the most common group of pathogens causing healthcare-associated infections. Some Enterobacterales can produce an enzyme called a carbapenemase that makes antibiotics like carbapenems, penicillins, and cephalosporins ineffective.

Bacteria from the Enterobacterales family, including Klebsiella species and Escherichia coli, can produce a carbapenemase. Carbapenemases are often produced from genes located on transferable elements that can spread resistance easily from germ to germ and person to person. CDC targets carbapenemase-producing CRE (CP-CRE) for detection and response because they can be spread easily and can be very difficult to treat. The AR Lab Network routinely performs phenotypic testing to detect the presence of carbapenemase activity and molecular testing to identify the presence of the following five targeted carbapenemase genes:

  • Klebsiella pneumoniae Carbapenemase (KPC)
  • New Delhi Metallo-beta-lactamase (NDM)
  • Verona Integron-encoded Metallo-beta-lactamase (VIM)
  • Imipenemase Metallo-beta-lactamase (IMP)
  • Oxacillinase-48-like beta-lactamase (OXA-48)

AR Lab Network data are presented in both aggregated and year-to-year formats. The AR Lab Network is not a traditional surveillance system; changes in year-to-year carbapenemase rates may also be reflective of year-to-year changes in testing priorities, methods, or volume, jurisdictional reporting criteria, and other factors. Year classification is defined by specimen collection date.

Data Source
AR Lab Network
Years Included
2017 - 2024
Resources

Carbapenemase Detection

Carbapenemase-positive (CP) means that an organism is positive for carbapenemase activity and/or has at least one of the five targeted carbapenemase genes detected. The frequency of carbapenemase gene detection varies by organism and is driven by several factors, including antibiotic use, environmental persistence, and infection control practices in individual healthcare facilities, and regional spread from nearby geographic locations.

Carbapenemases Detected in CRE or CP-CRE, All Years and Genus

Select data visualizations using the tabs above to view denominator or isolate type data. This graph displays the distribution of carbapenemases detected among CRE and CP-CRE isolates, by genus. Isolates with Other CP activity were positive for carbapenemase activity but negative for all five targeted genes (KPC, NDM, VIM, IMP, OXA-48), and thus a different carbapenemase or resistance mechanism is likely responsible for the carbapenemase activity detected.

Geographic Locations

The frequency of targeted carbapenemase gene detection varies by location and is driven by several factors, including antibiotic use and infection control practices in individual healthcare facilities, the underlying health and age of the patient population, and regional spread from nearby locations.

Carbapenemase Genes Detected in CRE or CP-CRE, All Years and State

Select data visualizations using the tabs above to view denominator or isolate type data. This map displays the percentage of CRE or CP-CRE with targeted gene detected, by state, from 2017 - 2024.

Carbapenemases Detected in CRE or CP-CRE, All Years and Region

Select data visualizations using the tabs above to view denominator or isolate type data. This graph displays the distribution of carbapenemases detected among CRE and CP-CRE isolates, by AR Lab Network Region, from 2017 - 2024. Isolates with Other CP activity were positive for carbapenemase activity but negative for all five targeted genes (KPC, NDM, VIM, IMP, OXA-48), and thus a different carbapenemase or resistance mechanism is likely responsible for the carbapenemase activity detected. View a map of the AR Lab Network regions on the CDC website.

Antimicrobial Susceptibility to Carbapenem Drugs

Antimicrobial susceptibility testing (AST) is a laboratory procedure that determines whether antibiotics, like carbapenems, might be effective in treating the bacteria being tested. Susceptibility to carbapenems may vary by the presence of a carbapenemase gene. Understanding how carbapenemase genes can affect carbapenem susceptibilities can help improve surveillance and detection of carbapenemase genes by setting containment priorities and helping to identify isolates for AR Lab Network testing.

Susceptibility to carbapenem drugs, by carbapenemase gene, 2017 - 2024

This table shows the percentage of CRE isolates that were not susceptible or had an intermediate or resistant interpretation for each carbapenem tested, by the presence or absence of a targeted carbapenemase gene. These data may be used by public health officials to recommend specific phenotypic definitions that will enhance reporting and submission of clinical isolates to public health for enhanced detection and surveillance of carbapenemase genes. This table is not intended to provide any information to assist with clinical decision making.

Antimicrobial susceptibility testing results were interpreted using the most current version of the CLSI M100 document for breakpoints where available.

* Isolates positive for more than one carbapenemase gene and isolates positive for carbapenemase activity but negative for all five targeted carbapenemase genes were excluded from the analysis.

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Footnotes

  • The AR Lab Network was not designed to be a traditional surveillance system. Isolates tested are a convenience sample and include clinical, surveillance, and outbreak specimens. Within each state, isolate submissions and testing are determined by state priorities and reporting regulations.
  • A map of the AR Lab Network regions is available at https://www.cdc.gov/antimicrobial-resistance-laboratory-networks/php/about/.
  • CP Isolates are defined as those testing positive for carbapenemase activity and/or any of the five targeted genes (KPC, NDM, VIM, IMP, OXA-48).
  • Carbapenem-resistant Enterobacterales (CRE) isolates were resistant to ertapenem, imipenem, meropenem, or doripenem using antimicrobial susceptibility testing breakpoints.
  • Carbapenem-resistant Pseudomonas aeruginosa (CRPA) isolates were resistant to imipenem, meropenem, or doripenem, using antimicrobial susceptibility testing breakpoints.
  • Carbapenem-resistant Acinetobacter baumannii (CRAB) isolates were resistant to imipenem, meropenem, or doripenem, using antimicrobial susceptibility testing breakpoints.
  • Carbapenemase gene screens aimed to detect colonization with bacteria carrying at least one of five targeted carbapenemase genes. Screens were positive when at least one of five targeted carbapenemase genes (KPC, NDM, VIM, IMP, OXA-48) was detected using real-time polymerase chain reaction (PCR).
  • Suggested Citation: CDC. Antibiotic Resistance & Patient Safety Portal (AR&PSP) AR Lab Network Data. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. https://arpsp.cdc.gov/.
  • Data displayed are updated as of June 2025. Given the structure of the AR Lab Network and its testing strategies, supplementary testing and the availability of improved methods and additional data may result in changes or corrections to data reported on PSP.