Multi-faceted strategies improve collection compliance and sample acceptance rate for carbapenem-resistant Enterobacteriaceae (CRE) active surveillance testing

Author(s):  
Christopher Sova ◽  
Sarah S. Lewis ◽  
Becky A. Smith ◽  
Staci Reynolds
2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S257-S257
Author(s):  
Eileen Campbell ◽  
Shelley Kester ◽  
Jessica Layell ◽  
Anupama Neelakanta ◽  
Gerald A Capraro ◽  
...  

Abstract Background Active surveillance testing (AST) for Carbapenem-resistant Enterobacteriaceae (CRE) to identify and isolate asymptomatic carriers has been recommended to help prevent patient to patient transmission. Optimal screening population, frequency, and testing method remain a subject of debate. Methods Beginning in 2012, all clinical cultures yielding a CRE isolate in an 898-bed teaching hospital were reviewed to determine whether the isolate was hospital-acquired (HA). HA CRE rates per 10,000 patient-days were calculated. From 1/2013 to 6/2015, in-house, culture-based point prevalence surveys were performed on rectal swabs from rotating units using the CDC recommended method. 7/2015 through 8/2016, culture-based AST was outsourced to a reference laboratory and AST was expanded to include high-risk patients on admission with weekly sweeps on high-risk units. Of note, revised CLSI breakpoints were implemented by our laboratory in 7/2016, which resulted in an increase in CRE detections. Surveillance was suspended from September 2016 to January 2018 when we resumed AST utilizing in-house PCR for KPC, NDM, OXA48, IMP and VIM mechanisms. Rates of HA CRE were compared between surveillance periods. Cohorting of patients in select units, focus on hand hygiene and isolation, antibiotic stewardship, and CHG bathing were ongoing throughout all time periods. Results 510 rectal swabs in 424 patients were positive for CRE. Additional clinical cultures yielding CRE were absent in 83% of those patients, so would otherwise have gone undetected. Of those patients with both positive AST and clinical culture, 70% had a positive AST result prior to their clinical culture (range 0–997 days, average 94 days, median 14.5 days prior to clinical culture). Compared with preceding periods with no surveillance, on admission and weekly CRE AST, whether utilizing culture based or PCR based screening, was associated with significantly lower rates of HA CRE. (See Table 1). Rates of HA CRE during the initial point prevalence AST period were unchanged compared with periods with no surveillance. Community-onset CRE did not significantly change in any of the time periods monitored (Figure 2). Conclusion On admission and weekly AST was associated with a significant decrease in HA CRE in a large teaching hospital. Disclosures All authors: No reported disclosures.


PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0231754
Author(s):  
Karen M. Ong ◽  
Michael S. Phillips ◽  
Charles S. Peskin

Widespread use of antibiotics has resulted in an increase in antimicrobial-resistant microorganisms. Although not all bacterial contact results in infection, patients can become asymptomatically colonized, increasing the risk of infection and pathogen transmission. Consequently, many institutions have begun active surveillance, but in non-research settings, the resulting data are often incomplete and may include non-random testing, making conventional epidemiological analysis problematic. We describe a mathematical model and inference method for in-hospital bacterial colonization and transmission of carbapenem-resistant Enterobacteriaceae that is tailored for analysis of active surveillance data with incomplete observations. The model and inference method make use of the full detailed state of the hospital unit, which takes into account the colonization status of each individual in the unit and not only the number of colonized patients at any given time. The inference method computes the exact likelihood of all possible histories consistent with partial observations (despite the exponential increase in possible states that can make likelihood calculation intractable for large hospital units), includes techniques to improve computational efficiency, is tested by computer simulation, and is applied to active surveillance data from a 13-bed rehabilitation unit in New York City. The inference method for exact likelihood calculation is applicable to other Markov models incorporating incomplete observations. The parameters that we identify are the patient–patient transmission rate, pre-existing colonization probability, and prior-to-new-patient transmission probability. Besides identifying the parameters, we predict the effects on the total prevalence (0.07 of the total colonized patient-days) of changing the parameters and estimate the increase in total prevalence attributable to patient–patient transmission (0.02) above the baseline pre-existing colonization (0.05). Simulations with a colonized versus uncolonized long-stay patient had 44% higher total prevalence, suggesting that the long-stay patient may have been a reservoir of transmission. High-priority interventions may include isolation of incoming colonized patients and repeated screening of long-stay patients.


2014 ◽  
Vol 35 (1) ◽  
pp. 82-84 ◽  
Author(s):  
David B. Banach ◽  
Jeannette Francois ◽  
Stephanie Blash ◽  
Gopi Patel ◽  
Stephen G. Jenkins ◽  
...  

Active surveillance to identify asymptomatic carriers of carbapenem-resistant Enterobacteriaceae (CRE) is a recommended strategy for CRE control in healthcare facilities. Active surveillance using stool specimens tested for Clostridium difficile is a relatively low-cost strategy to detect CRE carriers. Further evaluation of this and other risk factor-based active surveillance strategies is warranted.


2019 ◽  
Vol 40 (9) ◽  
pp. 1046-1049
Author(s):  
Kathleen Chiotos ◽  
Clare Rock ◽  
Marin L. Schweizer ◽  
Valerie M. Deloney ◽  
Daniel J. Morgan ◽  
...  

AbstractWe used a survey to characterize contemporary infection prevention and antibiotic stewardship program practices across 64 healthcare facilities, and we compared these findings to those of a similar 2013 survey. Notable findings include decreased frequency of active surveillance for methicillin-resistant Staphylococcus aureus, frequent active surveillance for carbapenem-resistant Enterobacteriaceae, and increased support for antibiotic stewardship programs.


2015 ◽  
Vol 53 (12) ◽  
pp. 3712-3714 ◽  
Author(s):  
Romney M. Humphries ◽  
James A. McKinnell

Detecting carbapenem-resistantEnterobacteriaceae(CRE) can be difficult. In particular, the absence of FDA-cleared automated antimicrobial susceptibility test (AST) devices that use revised Clinical and Laboratory Standards Institute (CLSI) carbapenem breakpoints forEnterobacteriaceaeand the lack of active surveillance tests hamper the clinical laboratory. In this issue of theJournal of Clinical Microbiology, Lau and colleagues (A. F. Lau, G. A. Fahle, M. A. Kemp, A. N. Jassem, J. P. Dekker, and K. M. Frank, J Clin Microbiol 53:3729–3737, 2015,http://dx.doi.org/10.1128/JCM.01921-15) evaluate the performance of a research-use-only PCR for the detection of CRE in rectal surveillance specimens.


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