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CREATE a Plan

For Veterinarians and Administrators


The CREATE a Plan section of the CREATE website focuses on what to do before CRE is found to be a problem at a veterinary facility. Below you will find some brief highlights but for the most comprehensive information, please download our full length document (PDF).

  • How to Recognize CRE
    • CRE are often first detected through routine culture and antimicrobial susceptibility testing (AST) of a suspected infection site (e.g. urine, wound).
    • Not all laboratories include a carbapenem in their standard panel so it may be necessary to request additional testing.
    • Culture and molecular testing approaches are available for detecting CRE.
  • Reporting CRE
    • When and who should report CRE to Public Health Officials can vary (and occasionally be confusing) from jurisdiction to jurisdiction.
    • Veterinary professionals in most jurisdictions have some sort of legal requirement to report unusual clusters of disease or pathogens high consequence.
    • Public Health reporting should be viewed as a positive step for developing a collaborative response.
  • Identifying a CRE Response Team
    • Should include internal stakeholders from all relevant hospital teams (I.e. clinicians, nursing, environmental management).
    • Also include internal liaisons to or representatives from your CRE testing laboratory and your public health department.
    • Identify a single individual with the authority to make time-sensitive decisions.
  • Funding a Response
    • Costs associated with a veterinary CRE outbreak may be significant depending on how long it has gone on and how many animals are affected.
    • Identifying funds that can be used immediately to respond to CRE is an important preparation step.
  • Flagging Systems
    • Identifying suspect or known CRE patients immediately upon presentation to your hospital is a critical first step.
  • Infection Control
    • Policies for hand hygiene, personal protective equipment (PPE), housing and environmental management can be developed prior to CRE outbreaks.
    • Training and assessment on these policies is critical for success.
  • Responsible Antibiotic Use
    • The judicious use of antimicrobials is an important component in the battle against CRE but should not be the only strategy used for prevention.
    • Even veterinary facilities that do not routinely use carbapenems are vulnerable to CRE introduction and spread because CRE are typically resistant to most antimicrobials.

Additional Resources