Healthcare Antibiotic Resistance Prevalence – DC (HARP - DC)- Measuring the Prevalence of Carbapenem Resistant Enterobacteriaceae in Healthcare Facilities (HCF) in Washington DC

Abstract Background Infections with metallo-β-lactamase (MBL)-producing organisms are emerging in the United States. Treatment options for these infections are limited. We describe MBL genes among carbapenemase positive carbapenem-resistant Enterobacteriaceae (CP-CRE) and Pseudomonas aeruginosa (CP-CRPA) isolates tested during the first two years of the Antibiotic Resistance Laboratory Network (AR Lab Network). Methods State and local public health laboratories tested CRE and CRPA isolates for organism identification, antimicrobial susceptibility, and PCR-based detection of blaKPC, blaNDM, blaOXA-48-like, blaVIM, and blaIMP carbapenemase genes. All testing results were sent to CDC at least monthly. Results Since January 2017, the AR Lab Network tested 21,733 CRE and 14,141 CRPA. CP-CRE were detected in 37% of CRE; 2% of CRPA were CP-CRPA. Among CP-CRE, 9% (686/8016) were MBL-producers (NDM, VIM, or IMP). Among MBL-producers, a blaNDM gene was detected most often (81%; 551/686). blaNDM were most common among Klebsiella spp. (47%; 261/551), blaIMP were most common among Providencia spp. (53%; 40/75), blaVIM was most common among Enterobacter spp. (19%; 25/62). Twelve percent (96) of MBL CP-CRE contained more than one carbapenemase gene. Among CP-CRPA, 73% (218/300) were MBL producers and blaVIM was the most common gene (62%; 186). Three (1%) MBL CP-CRPA contained more than one carbapenemase. Conclusion Increased testing of CRE and CRPA isolates through the AR Lab Network has facilitated early and rapid detection of hard-to-treat infections caused by MBL-producing organisms across the United States. The widespread distribution of MBL genes highlights the continued need for containment strategies that help prevent transmission between patients and among healthcare facilities. To support therapeutic decisions for severe infections caused by MBL-producing organisms, the AR Lab Network is now offering rapid susceptibility testing against aztreonam/avibactam, using digital dispenser technology. This testing program aims to close the gap between the availability of new drugs or drug combinations and the availability of commercial AST methods, thereby improving patient safety and antimicrobial stewardship. Disclosures All authors: No reported disclosures.

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Predictors of Rectal Carriage of Carbapenem-Resistant Enterobacteriaceae (CRE) among Patients with Known CRE Carriage at Their Next Hospital Encounter

Infection Control and Hospital Epidemiology ◽

10.1086/659762 ◽

2011 ◽

Vol 32 (5) ◽

pp. 497-503 ◽

Cited By ~ 50

Author(s):

Vered Schechner ◽

Tali Kotlovsky ◽

Jalal Tarabeia ◽

Meital Kazma ◽

David Schwartz ◽

...

Keyword(s):

Screen Test ◽

Healthcare Facility ◽

Negative Control ◽

Time Interval ◽

Healthcare Facilities ◽

Positive Screen ◽

Carbapenem Resistant ◽

History Of ◽

Control Study ◽

Carbapenem Resistant Enterobacteriaceae

Background.Carbapenem-resistant Enterobacteriaceae (CRE) are important extremely drug-resistant pathogens that have emerged during the past decade. Early identification and isolation of carriers are key components of an effective infection control strategy in healthcare facilities. Very little is known about the natural history of CRE carriage. We aimed to determine the predictors of a positive CRE rectal screen test among patients with known CRE carriage screened at their next hospital encounter.Methods.A case-control study was conducted. Sixty-six patients who tested positive for CRE carriage were surveyed for CRE rectal carriage at the next hospital encounter; screen-positive patients were compared with screen-negative control patients. Data were extracted from the patients' medical records and from the hospital computerized database.Results.Twenty-three case patients and 43 control patients were identified. Predictors for a positive CRE rectal carriage test were (1) prior fluoroquinolone use (odds ratio [OR], 4.27; 95% confidence interval [CI], 1.10–16.6), (2) admission from an institution or another hospital (OR, 4.04; 95% CI, 1.33–12.37), and (3) time interval less than or equal to 3 months since the first positive CRE test (OR, 3.59; 95% CI, 1.24–10.37). Among patients with no predictor variables, the likelihood of having a positive screen test at the next hospital encounter was 1/7. If they had at least 1 predictor, the likelihood increased to 1/2.Conclusions.Prior fluoroquinolone use, transfer from another healthcare facility, and admission less than or equal to 3 months since the first CRE isolation are predictors of persistent CRE rectal carriage. These predictors can be used in designing CRE prevention strategies.

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Nosocomial Pathogens: An In-Depth Analysis of the Vectorial Potential of Cockroaches

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed4010014 ◽

2019 ◽

Vol 4 (1) ◽

pp. 14 ◽

Cited By ~ 6

Author(s):

Eric S. Donkor

Keyword(s):

Nosocomial Infections ◽

Social Consequences ◽

Antibiotic Resistant ◽

Nosocomial Pathogens ◽

Healthcare Facilities ◽

Carbapenem Resistant ◽

Depth Analysis ◽

Healthcare Associated ◽

Carbapenem Resistant Enterobacteriaceae

Nosocomial or healthcare-associated infections are regarded as the most frequent adverse event that threatens patients’ safety and has serious economic and social consequences. Cockroach infestation is common in many hospitals, especially in the developing world. Common nosocomial pathogens isolated from cockroaches include Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. Cockroaches also harbor epidemiologically significant antibiotic-resistant organisms, such as carbapenem-resistant Enterobacteriaceae, which complicate nosocomial infections. Therefore, cockroaches constitute an important vector for nosocomial pathogens, and there should be zero tolerance for their presence in healthcare facilities. This paper aims to elucidate the possible role of cockroaches in nosocomial infections by reviewing the relevant research publications.

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Statewide Surveillance of Carbapenem-Resistant Enterobacteriaceae in Michigan

Infection Control and Hospital Epidemiology ◽

10.1086/675611 ◽

2014 ◽

Vol 35 (4) ◽

pp. 342-349 ◽

Cited By ~ 20

Author(s):

Brenda M. Brennan ◽

Joseph R. Coyle ◽

Dror Marchaim ◽

Jason M. Pogue ◽

Martha Boehme ◽

...

Keyword(s):

Data Collection ◽

Acute Care ◽

Multidrug Resistant ◽

Fourth Generation ◽

Public Health Issue ◽

Resistant Organism ◽

Recent Infection ◽

Healthcare Facilities ◽

Carbapenem Resistant ◽

Carbapenem Resistant Enterobacteriaceae

Background.Carbapenem-resistant Enterobacteriaceae (CRE) are clinically challenging, threaten patient safety, and represent an emerging public health issue. CRE reporting is not mandated in Michigan.Methods.The Michigan Department of Community Health–led CRE Surveillance and Prevention Initiative enrolled 21 facilities (17 acute care and 4 long-term acute care facilities) across the state. Baseline data collection began September 1, 2012, and ended February 28, 2013 (duration, 6 months). Enrolled facilities voluntarily reported cases of Klebsiella pneumoniae and Escherichia coli according to the surveillance algorithm. Patient demographic characteristics, laboratory testing, microbiology, clinical, and antimicrobial information were captured via standardized data collection forms. Facilities reported admissions and patient-days each month.Results.One-hundred two cases over 957,220 patient-days were reported, resulting in a crude incidence rate of 1.07 cases per 10,000 patient-days. Eighty-nine case patients had test results positive for K. pneumoniae, whereas 13 had results positive for E. coli. CRE case patients had a mean age of 63 years, and 51% were male. Urine cultures (61%) were the most frequently reported specimen source. Thirty-five percent of cases were hospital onset; sixty-five percent were community onset (CO), although 75% of CO case patients reported healthcare exposure within the previous 90 days. Cardiovascular disease, renal failure, and diabetes mellitus were the most frequently reported comorbid conditions. Common ris k factors included surgery within the previous 90 days, recent infection or colonization with a multidrug-resistant organism, and recent exposures to antimicrobials, especially third- or fourth-generation cephalosporins.Conclusions.CRE are found throughout Michigan healthcare facilities. Implementing a regional, coordinated surveillance and prevention initiative may prevent CRE from becoming hyperendemic in Michigan.

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Superbugs: Antibiotic Resistance Is Becoming a Major Public Health Concern

Home Health Care Management & Practice ◽

10.1177/1084822316659285 ◽

2016 ◽

Vol 29 (2) ◽

pp. 130-133 ◽

Cited By ~ 6

Author(s):

Patricia T. Alpert

Keyword(s):

Public Health ◽

Antibiotic Resistance ◽

Clostridium Difficile ◽

Current Treatment ◽

Health Concern ◽

Treatment Modalities ◽

Public Health Concern ◽

Carbapenem Resistant ◽

Control And Prevention ◽

Carbapenem Resistant Enterobacteriaceae

Antibiotic resistance has led to the development of so-called “superbugs” that no longer respond to the current treatment modalities. The array of antibiotics available to treat these infections is dwindling with very few antibiotics in the pipeline. This article discussed the pathogens the Centers for Disease Control and Prevention (CDC) has placed in their urgent category: (1) Clostridium difficile, (2) Carbapenem-resistant Enterobacteriaceae, and (3) Neisseria gonorrhoeae. In addition, a few suggestions for prevention of resistance are offered.

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Healthcare Antibiotic Resistance Prevalence – DC (HARP-DC): A Regional Prevalence Assessment of Carbapenem-Resistant Enterobacteriaceae (CRE) in Healthcare Facilities in Washington, District of Columbia

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.110 ◽

2017 ◽

Vol 38 (8) ◽

pp. 921-929 ◽

Cited By ~ 2

Author(s):

Jacqueline Reuben ◽

Nancy Donegan ◽

Glenn Wortmann ◽

Roberta DeBiasi ◽

Xiaoyan Song ◽

...

Keyword(s):

District Of Columbia ◽

Inpatient Rehabilitation ◽

Healthcare Facilities ◽

Rehabilitation Facility ◽

Carbapenem Resistant ◽

Care Facilities ◽

Inpatient Rehabilitation Facility ◽

Prevalence Ratios ◽

Carbapenem Resistant Enterobacteriaceae

OBJECTIVECarbapenem-resistant Enterobacteriaceae (CRE) are a significant clinical and public health concern. Understanding the distribution of CRE colonization and developing a coordinated approach are key components of control efforts. The prevalence of CRE in the District of Columbia is unknown. We sought to determine the CRE colonization prevalence within healthcare facilities (HCFs) in the District of Columbia using a collaborative, regional approach.DESIGNPoint-prevalence study.SETTINGThis study included 16 HCFs in the District of Columbia: all 8 acute-care hospitals (ACHs), 5 of 19 skilled nursing facilities, 2 (both) long-term acute-care facilities, and 1 (the sole) inpatient rehabilitation facility.PATIENTSInpatients on all units excluding psychiatry and obstetrics-gynecology.METHODSCRE identification was performed on perianal swab samples using real-time polymerase chain reaction, culture, and antimicrobial susceptibility testing (AST). Prevalence was calculated by facility and unit type as the number of patients with a positive result divided by the total number tested. Prevalence ratios were compared using the Poisson distribution.RESULTSOf 1,022 completed tests, 53 samples tested positive for CRE, yielding a prevalence of 5.2% (95% CI, 3.9%–6.8%). Of 726 tests from ACHs, 36 (5.0%; 95% CI, 3.5%–6.9%) were positive. Of 244 tests from long-term-care facilities, 17 (7.0%; 95% CI, 4.1%–11.2%) were positive. The relative prevalence ratios by facility type were 0.9 (95% CI, 0.5–1.5) and 1.5 (95% CI, 0.9–2.6), respectively. No CRE were identified from the inpatient rehabilitation facility.CONCLUSIONA baseline CRE prevalence was established, revealing endemicity across healthcare settings in the District of Columbia. Our study establishes a framework for interfacility collaboration to reduce CRE transmission and infection.Infect Control Hosp Epidemiol 2017;38:921–929

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Active Surveillance for Carbapenem-Resistant Enterobacteriaceae Using Stool Specimens Submitted for Testing for Clostridium difficile

Infection Control and Hospital Epidemiology ◽

10.1086/674391 ◽

2014 ◽

Vol 35 (1) ◽

pp. 82-84 ◽

Cited By ~ 12

Author(s):

David B. Banach ◽

Jeannette Francois ◽

Stephanie Blash ◽

Gopi Patel ◽

Stephen G. Jenkins ◽

...

Keyword(s):

Risk Factor ◽

Clostridium Difficile ◽

Active Surveillance ◽

Low Cost ◽

Healthcare Facilities ◽

Carbapenem Resistant ◽

Cost Strategy ◽

Stool Specimens ◽

Low Cost Strategy ◽

Carbapenem Resistant Enterobacteriaceae

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.

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Current infection prevention and antibiotic stewardship program practices: A survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN)

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.172 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1046-1049

Author(s):

Kathleen Chiotos ◽

Clare Rock ◽

Marin L. Schweizer ◽

Valerie M. Deloney ◽

Daniel J. Morgan ◽

...

Keyword(s):

Active Surveillance ◽

Antibiotic Stewardship ◽

Infection Prevention ◽

Research Network ◽

Healthcare Facilities ◽

Carbapenem Resistant ◽

Stewardship Program ◽

Current Infection ◽

Healthcare Epidemiology ◽

Carbapenem Resistant Enterobacteriaceae

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.

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