scholarly journals A mathematical model and inference method for bacterial colonization in hospital units applied to active surveillance data for carbapenem-resistant enterobacteriaceae

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0231754
Author(s):  
Karen M. Ong ◽  
Michael S. Phillips ◽  
Charles S. Peskin
Keyword(s):  
Mathematical Model ◽  
Active Surveillance ◽  
Bacterial Colonization ◽  
Surveillance Data ◽  
Inference Method ◽  
Hospital Units ◽  
Carbapenem Resistant ◽  
Incomplete Observations ◽  
Total Prevalence ◽  
Carbapenem Resistant Enterobacteriaceae

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.

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

2014 ◽  
Vol 35 (1) ◽  
pp. 82-84 ◽  
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.

scholarly journals Epidemiology of Carbapenem-resistant Enterobacteriaceae in Egyptian intensive care units using National Healthcare–associated Infections Surveillance Data, 2011–2017

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Sara Kotb ◽  
Meghan Lyman ◽  
Ghada Ismail ◽  
Mohammad Abd El Fattah ◽  
Samia A. Girgis ◽  
...  
Keyword(s):  
Intensive Care ◽  
Surveillance System ◽  
Carbapenem Resistance ◽  
Surveillance Data ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infections ◽  
Specimen Type ◽  
Carbapenem Resistant ◽  
Healthcare Associated ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Objective To describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) healthcare-associated infections (HAI) in Egyptian hospitals reporting to the national HAI surveillance system. Methods Design: Descriptive analysis of CRE HAIs and retrospective observational cohort study using national HAI surveillance data. Setting: Egyptian hospitals participating in the HAI surveillance system. The patient population included patients admitted to the intensive care unit (ICU) in participating hospitals. Enterobacteriaceae HAI cases were Klebsiella, Escherichia coli, and Enterobacter isolates from blood, urine, wound or respiratory specimen collected on or after day 3 of ICU admission. CRE HAI cases were those resistant to at least one carbapenem. For CRE HAI cases reported during 2011–2017, a hospital-level and patient-level analysis were conducted using only the first CRE isolate by pathogen and specimen type for each patient. For facility, microbiology, and clinical characteristics, frequencies and means were calculated among CRE HAI cases and compared with carbapenem-susceptible Enterobacteriaceae HAI cases through univariate and multivariate logistic regression using STATA 13. Results There were 1598 Enterobacteriaceae HAI cases, of which 871 (54.1%) were carbapenem resistant. The multivariate regression analysis demonstrated that carbapenem resistance was associated with specimen type, pathogen, location prior to admission, and length of ICU stay. Between 2011 and 2017, there was an increase in the proportion of Enterobacteriaceae HAI cases due to CRE (p-value = 0.003) and the incidence of CRE HAIs (p-value = 0.09). Conclusions This analysis demonstrated a high and increasing burden of CRE in Egyptian hospitals, highlighting the importance of enhancing infection prevention and control (IPC) programs and antimicrobial stewardship activities and guiding the implementation of targeted IPC measures to contain CRE in Egyptian ICU’s .

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

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.

Carbapenem-Resistant Klebsiella pneumoniae Producing New Delhi Metallo-β-Lactamase at an Acute Care Hospital, Colorado, 2012

2014 ◽  
Vol 35 (4) ◽  
pp. 390-397 ◽  
Author(s):  
Erin E. Epson ◽  
Larissa M. Pisney ◽  
Joyanna M. Wendt ◽  
Duncan R. MacCannell ◽  
Sarah J. Janelle ◽  
...  
Keyword(s):  
Acute Care ◽  
Medical Records ◽  
Acute Care Hospital ◽  
New Delhi ◽  
Care Hospital ◽  
Hospital Units ◽  
Direct Observations ◽  
Carbapenem Resistant ◽  
Polymerase Chain ◽  
Carbapenem Resistant Enterobacteriaceae

Objective.To investigate an outbreak of New Delhi metallo-β-lactamase (NDM)–producing carbapenem-resistant Enterobacteriaceae (CRE) and determine interventions to interrupt transmission.Design, Setting, and Patients.Epidemiologic investigation of an outbreak of NDM-producing CRE among patients at a Colorado acute care hospital.Methods.Case patients had NDM-producing CRE isolated from clinical or rectal surveillance cultures (SCs) collected during the period January 1, 2012, through October 20, 2012. Case patients were identified through microbiology records and 6 rounds of SCs in hospital units where they had resided. CRE isolates were tested by real-time polymerase chain reaction for blaNDM. Medical records were reviewed for epidemiologic links; relatedness of isolates was evaluated by pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). Infection control (IC) was assessed through staff interviews and direct observations.Results.Two patients were initially identified with NDM-producing CRE during July–August 2012. A third case patient, admitted in May, was identified through microbiology records review. SC identified 5 additional case patients. Patients had resided in 11 different units before identification. All isolates were highly related by PFGE. WGS suggested 3 clusters of CRE. Combining WGS with epidemiology identified 4 units as likely transmission sites. NDM-producing CRE positivity in certain patients was not explained by direct epidemiologic overlap, which suggests that undetected colonized patients were involved in transmission.Conclusions.A 4-month outbreak of NDM-producing CRE occurred at a single hospital, highlighting the risk for spread of these organisms. Combined WGS and epidemiologic data suggested transmission primarily occurred on 4 units. Timely SC, combined with targeted IC measures, were likely responsible for controlling transmission.

scholarly journals Continuing Challenges for the Clinical Laboratory for Detection of Carbapenem-Resistant Enterobacteriaceae

2015 ◽  
Vol 53 (12) ◽  
pp. 3712-3714 ◽  
Author(s):  
Romney M. Humphries ◽  
James A. McKinnell
Keyword(s):  
Active Surveillance ◽  
Antimicrobial Susceptibility ◽  
Clinical Microbiology ◽  
Clinical Laboratory ◽  
Research Use ◽  
Antimicrobial Susceptibility Test ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Surveillance Specimens ◽  
Carbapenem Resistant Enterobacteriaceae

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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