Corresponding Author

Kevin Spicer


Author Affiliations

1. Mary Isaac, MPH, BDS: Epidemiologist, Healthcare-Associated Infection / Antibiotic Resistance Prevention Program, Division of Epidemiology and Health Planning
Kentucky Department for Public Health (KDPH) (Frankfort KY)

2. Andrea Flinchum, MPH, BSN, RN: Manager (Healthcare-Associated Infection / Antibiotic Resistance Prevention Program) and Epidemiologist, KDPH

3. Kevin B. Spicer, MD, PhD, MPH
CDC Medical Officer, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infection Diseases, CDC
Pediatric infectious disease specialist, KDPH; Email: kevin.spicer@ky.gov

Author Area of Expertise

Mary Issac: Epidemiologist, Healthcare-Associated Infection Prevention, Dentistry

Andrea Flinchum: Manager of Healthcare-Associated Infection/Antibiotic Resistance Prevention Program, Epidemiologist, Registered Nurse

Kevin Spicer: CDC Medical officer, Healthcare-Associated Infection Prevention and Antibiotic Resistance, Pediatric Infectious Disease specialist


Introduction: Carbapenem-resistant Enterobacterales (CRE) are considered urgent, antibiotic-resistant threats in the U.S. and are of global concern. Active collaboration between public health authorities and healthcare facilities and providers will be necessary to prevent and contain these organisms.

Purpose: To describe the epidemiology of CRE in Kentucky and to discuss challenges and successes with building and sustaining an effective prevention and containment program.

Methods: Retrospective descriptive summary of CRE isolates reported by healthcare providers, facilities, and laboratories in Kentucky from 2013 through 2020. Data available from case reporting forms and laboratory testing are summarized.

Results: From 2013 through 2020, 1805 CRE were reported from 1666 individuals; median age was 66 years and 44% were male. Although most reports were from hospitalized individuals, nearly one-third were from individuals not hospitalized in acute-care hospital settings. The number of reports generally increased over time, with 111 CRE isolates in 2013 and 477 in 2020. Klebsiella pneumoniae was the most frequently reported CRE. Of the 29% of CRE with identified carbapenemase production (CP-CRE), Klebsiella pneumoniae carbapenemase (KPC) was most common (78%). Surveillance and reporting resulted in identification and active investigation of 11 outbreaks of CP-CRE.

Implications: There are challenges with developing, implementing, and sustaining a consistent, effective response to identifying, preventing, and containing CRE. Ongoing public health and facility resources will be necessary to prevent and contain antibiotic-resistant threats and other concerning organisms.



Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Isaac M, Flinchum A, Spicer KB. Carbapenem-resistant Enterobacterales—Kentucky, 2013–2020: Challlenges and successes. J Appalach Health 2023;5(3):53–70. DOI: https://doi.org/10.13023/jah.0503.05