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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

  • Jacqueline Reuben (a1), Nancy Donegan (a2), Glenn Wortmann (a3), Roberta DeBiasi (a4), Xiaoyan Song (a5), Princy Kumar (a6), Mary McFadden (a7), Sylvia Clagon (a8), Janet Mirdamadi (a9), Diane White (a10), Jo Ellen Harris (a11), Angella Browne (a12), Jane Hooker (a13), Michael Yochelson (a14), Milena Walker (a15), Gary Little (a15), Gail Jernigan (a16), Kathleen Hansen (a17), Brenda Dockery (a17), Brendan Sinatro (a2), Morris Blaylock (a18), Kimary Harmon (a18), Preetha Iyengar (a1), Trevor Wagner (a19), Jo Anne Nelson (a2) and HARP Study Team...



Carbapenem-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.


Point-prevalence study.


This 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.


Inpatients on all units excluding psychiatry and obstetrics-gynecology.


CRE 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.


Of 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.


A 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


Corresponding author

Address correspondence to Jacqueline Reuben, DC Department of Health, Center for Policy Planning and Evaluation, 899 N Capitol St NE, 6th Floor, Washington, DC 20001 (


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PREVIOUS PRESENTATION. These study results were presented at 2016 ID Week on October 28, 2016, in New Orleans, Louisiana.



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