Active screening and interfacility communication of carbapenem-resistant Enterobacteriaceae (CRE) in a tertiary-care hospital

Shimasaki, Teppei; Segreti, John; Tomich, Alexander; Kim, Julie; Hayden, Mary K.; Lin, Michael; Program, Cdc Prevention Epicenters

doi:10.1017/ice.2018.150

Cited by 18 publications

(19 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This estimate is higher than the proportion of CRE (3.1%) among clinical isolates reported to the National Healthcare Safety Network in 2015 24 and considerably higher than the 0.5% CRE admission prevalence recently reported at a Chicago tertiary-care hospital (2013 data from ICU populations). 16 Importantly, most colonized patients (54%) were not on contact precautions at unit admission (for any indication), posing a potential reservoir for transmission during their unit encounter.…”

Section: Discussionmentioning

confidence: 99%

“…However, recent CRE data indicate that existing targeted screening policies (eg, for recent foreign hospitalization, on direct transfer from outside facilities) miss many colonized patients. 16,17 Better identifying predictors of colonization and developing algorithms to predict colonization probability may improve targeted screening approaches. Existing strategies often rely on risk factors (ie, "independent" variables), but strong risk factors may not be good predictors.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Predicting probability of perirectal colonization with carbapenem-resistant Enterobacteriaceae (CRE) and other carbapenem-resistant organisms (CROs) at hospital unit admission

Goodman

Simner

Klein

et al. 2019

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

Background:Targeted screening for carbapenem-resistant organisms (CROs), including carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing organisms (CPOs), remains limited; recent data suggest that existing policies miss many carriers.Objective:Our objective was to measure the prevalence of CRO and CPO perirectal colonization at hospital unit admission and to use machine learning methods to predict probability of CRO and/or CPO carriage.Methods:We performed an observational cohort study of all patients admitted to the medical intensive care unit (MICU) or solid organ transplant (SOT) unit at The Johns Hopkins Hospital between July 1, 2016 and July 1, 2017. Admission perirectal swabs were screened for CROs and CPOs. More than 125 variables capturing preadmission clinical and demographic characteristics were collected from the electronic medical record (EMR) system. We developed models to predict colonization probabilities using decision tree learning.Results:Evaluating 2,878 admission swabs from 2,165 patients, we found that 7.5% and 1.3% of swabs were CRO and CPO positive, respectively. Organism and carbapenemase diversity among CPO isolates was high. Despite including many characteristics commonly associated with CRO/CPO carriage or infection, overall, decision tree models poorly predicted CRO and CPO colonization (C statistics, 0.57 and 0.58, respectively). In subgroup analyses, however, models did accurately identify patients with recent CRO-positive cultures who use proton-pump inhibitors as having a high likelihood of CRO colonization.Conclusions:In this inpatient population, CRO carriage was infrequent but was higher than previously published estimates. Despite including many variables associated with CRO/CPO carriage, models poorly predicted colonization status, likely due to significant host and organism heterogeneity.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Predicting probability of perirectal colonization with carbapenem-resistant Enterobacteriaceae (CRE) and other carbapenem-resistant organisms (CROs) at hospital unit admission

Goodman

Simner

Klein

et al. 2019

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

show abstract

“…8 Unfortunately, our survey revealed that positive CRE/CP-CRE status is communicated less than half the time to the patient, a finding previously demonstrated in other studies including those in non-VA settings. 9,10 The greater proportion of respondents reported transfer communication between VA facilities in our survey is encouraging and may be due to their common EHR. However, the implementation of standardized interfacility transfer notification and the development of regional CRE/CP-CRE registries are important steps toward improving communication.…”

Section: Discussionmentioning

confidence: 76%

A survey of infection control strategies for carbapenem-resistant Enterobacteriaceae in Department of Veterans’ Affairs facilities

Ramanathan

Suda

Fitzpatrick

et al. 2020

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

A survey of Veterans’ Affairs Medical Centers on control of carbapenem-resistant Enterobacteriaceae (CRE) and carbapenem-producing CRE (CP-CRE) demonstrated that most facilities use VA guidelines but few screen for CRE/CP-CRE colonization regularly or regularly communicate CRE/CP-CRE status at patient transfer. Most respondents were knowledgeable about CRE guidelines but cited lack of adequate resources.

show abstract

“…In decreased the spread of multidrug-resistant organisms in inpatient health care settings (16,17). Additionally, antibiotic exposure has been associated with communityacquired ESBL-Ent in adults in Chicago (18).…”

Section: Discussionmentioning

confidence: 99%

A Pilot Study of Chicago Waterways as Reservoirs of Multidrug-Resistant Enterobacteriaceae (MDR-Ent) in a High-Risk Region for Community-Acquired MDR-Ent Infection in Children

Logan

Zhang

Green

et al. 2020

Antimicrob Agents Chemother

Self Cite

View full text Add to dashboard Cite

Community-acquired multidrug resistant Enterobacteriaceae (MDR-Ent) infections continue to increase in the United States. In prior studies, we identified neighboring regions in Chicago, Illinois, where children have 5 to 6 times greater odds of MDR-Ent infections. To prevent community spread of MDR-Ent, we need to identify the MDR-Ent reservoirs. A pilot study of 4 Chicago waterways for MDR-Ent and associated antibiotic resistance genes (ARGs) was conducted. Three waterways (A1 to A3) are labeled safe for “incidental contact recreation” (e.g., kayaking), and A4 is a nonrecreational waterway that carries nondisinfected water. Surface water samples were collected and processed for standard bacterial culture and shotgun metagenomic sequencing. Generally, A3 and A4 (neighboring waterways which are not hydraulically connected) were strikingly similar in bacterial taxa, ARG profiles, and abundances of corresponding clades and genera within the Enterobacteriaceae. Additionally, total ARG abundances recovered from the full microbial community were strongly correlated between A3 and A4 (R2 = 0.97). Escherichia coli numbers (per 100 ml water) were highest in A4 (783 most probable number [MPN]) and A3 (200 MPN) relative to A2 (84 MPN) and A1 (32 MPN). We found concerning ARGs in Enterobacteriaceae such as MCR-1 (colistin), Qnr and OqxA/B (quinolones), CTX-M, OXA and ACT/MIR (beta-lactams), and AAC (aminoglycosides). We found significant correlations in microbial community composition between nearby waterways that are not hydraulically connected, suggesting cross-seeding and the potential for mobility of ARGs. Enterobacteriaceae and ARG profiles support the hypothesized concerns that recreational waterways are a potential source of community-acquired MDR-Ent.

show abstract

Active screening and interfacility communication of carbapenem-resistant Enterobacteriaceae (CRE) in a tertiary-care hospital

Cited by 18 publications

References 23 publications

Predicting probability of perirectal colonization with carbapenem-resistant Enterobacteriaceae (CRE) and other carbapenem-resistant organisms (CROs) at hospital unit admission

Predicting probability of perirectal colonization with carbapenem-resistant Enterobacteriaceae (CRE) and other carbapenem-resistant organisms (CROs) at hospital unit admission

A survey of infection control strategies for carbapenem-resistant Enterobacteriaceae in Department of Veterans’ Affairs facilities

A Pilot Study of Chicago Waterways as Reservoirs of Multidrug-Resistant Enterobacteriaceae (MDR-Ent) in a High-Risk Region for Community-Acquired MDR-Ent Infection in Children

Contact Info

Product

Resources

About