Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-24T19:20:37.160Z Has data issue: false hasContentIssue false
  • English
  • Français

Provider Role in Transmission of Carbapenem-Resistant Enterobacteriaceae

Published online by Cambridge University Press:  24 October 2017

Marika E. Grabowski ,
Hyojung Kang ,
Kristen M. Wells ,
Costi D. Sifri ,
Amy J. Mathers  and
Jennifer M. Lobo
Marika E. Grabowski
Affiliation:
Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
Hyojung Kang
Affiliation:
Department of Systems and Information Engineering, University of Virginia, Charlottesville, Virginia
Kristen M. Wells
Affiliation:
Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
Costi D. Sifri
Affiliation:
Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia
Amy J. Mathers
Affiliation:
Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia
Jennifer M. Lobo*
Affiliation:
Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
*
Address correspondence to Jennifer M. Lobo, PhD, 1300 Jefferson Park Avenue, PO Box 800717, Charlottesville, VA 22908 (jem4yb@virginia.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

We sought to evaluate the role healthcare providers play in carbapenem-resistant Enterobacteriaceae (CRE) acquisition among hospitalized patients.

DESIGN

A 1:4 case-control study with incidence density sampling.

SETTING

Academic healthcare center with regular CRE perirectal screening in high-risk units.

PATIENTS

We included case patients with ≥1 negative CRE test followed by positive culture with a length of stay (LOS) >9 days. For controls, we included patients with ≥2 negative CRE tests and assignment to the same unit set as case patients with a LOS >9 days.

METHODS

Controls were time-matched to each case patient. Case exposure was evaluated between days 2 and 9 before positive culture and control evaluation was based on maximizing overlap with the case window. Exposure sources were all CRE-colonized or -infected patients. Nonphysician providers were compared between study patients and sources during their evaluation windows. Dichotomous and continuous exposures were developed from the number of source-shared providers and were used in univariate and multivariate regression.

RESULTS

In total, 121 cases and 484 controls were included. Multivariate analysis showed odds of dichotomous exposure (≥1 source-shared provider) of 2.27 (95% confidence interval [CI], 1.25–4.15; P=.006) for case patients compared to controls. Multivariate continuous exposure showed odds of 1.02 (95% CI, 1.01–1.03; P=.009) for case patients compared to controls.

CONCLUSIONS

Patients who acquire CRE during hospitalization are more likely to receive care from a provider caring for a patient with CRE than those patients who do not acquire CRE. These data support the importance of hand hygiene and cohorting measures for CRE patients to reduce transmission risk.

Infect Control Hosp Epidemiol 2017;38:1329–1334

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 11 , November 2017 , pp. 1329 - 1334
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care–associated infections. N Engl J Med 2014;370:1198–1208.Google Scholar
2. Umscheid, CA, Mitchell, MD, Doshi, JA, Agarwal, R, Williams, K, Brennan, PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32:101–114.Google Scholar
3. Allegranzi, B, Pittet, D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect 2009;73:305–315.CrossRefGoogle ScholarPubMed
4. Zawacki, A, O’Rourke, E, Potter-Bynoe, G, Macone, A, Harbarth, S, Goldmann, D. An outbreak of Pseudomonas aeruginosa pneumonia and bloodstream infection associated with intermittent otitis externa in a healthcare worker. Infect Control Hosp Epidemiol 2004;25:1083–1089.Google Scholar
5. Moolenaar, RL, Crutcher, JM, San Joaquin, VH, et al. A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit did staff fingernails play a role in disease transmission? Infect Control Hosp Epidemiol 2000;21:80–85.CrossRefGoogle Scholar
6. US Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. Centers for Disease Control and Prevention, US Department of Health and Human Services; 2013.Google Scholar
7. Ben-David, D, Kordevani, R, Keller, N, et al. Outcome of carbapenem resistant Klebsiella pneumoniae bloodstream infections. Clin Microbiol Infect 2012;18:54–60.CrossRefGoogle ScholarPubMed
8. Patel, G, Huprikar, S, Factor, SH, Jenkins, SG, Calfee, DP. Outcomes of carbapenem‐resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008;29:1099–1106.Google Scholar
9. Tracking CRE. US Centers for Disease Control and Prevention website. www.cdc.gov/hai/organisms/cre/TrackingCRE.html. Updated 2017. Accessed September 25, 2017.Google Scholar
10. Summary of state CRE reporting requirements. Association for Professionals in Infection Control and Epidemiology website. www.apic.org/Resource_/TinyMceFileManager/Advocacy-PDFs/CRE_ReportingRequirements_Final.pdf. Published 2013. Accessed September 25, 2017.Google Scholar
11. Most hospitals aren’t required to report superbug outbreaks. Should they be? Advisory Board Web site. www.advisory.com/daily-briefing/2015/03/11/superbug-outbreaks. Updated 2015. Accessed September 25, 2017.Google Scholar
12. U.S. Centers for Disease Control and Prevention. Facility guidance for control of carbapenem-resistant Enterobacteriaceae (CRE). November 2015 Update - CRE Toolkit. 2015.Google Scholar
13. Enfield, KB, Huq, NN, Gosseling, MF, et al. Control of simultaneous outbreaks of carbapenemase-producing enterobacteriaceae and extensively drug-resistant Acinetobacter baumannii infection in an intensive care unit using interventions promoted in the Centers for Disease Control and Prevention 2012 carbapenemase-resistant Enterobacteriaceae toolkit. Infect Control Hosp Epidemiol 2014;35:810–817.Google Scholar
14. Correa, L, Martino, MDV, Siqueira, I, et al. A hospital-based matched case–control study to identify clinical outcome and risk factors associated with carbapenem-resistant Klebsiella pneumoniae infection. BMC Infect Dis 2013;13:1.CrossRefGoogle ScholarPubMed
15. Schwartz-Neiderman, A, Braun, T, Fallach, N, Schwartz, D, Carmeli, Y, Schechner, V. Risk factors for carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) acquisition among contacts of newly diagnosed CP-CRE patients. Infect Control Hosp Epidemiol 2016;37:1219–1225.CrossRefGoogle ScholarPubMed
16. Swaminathan, M, Sharma, S, Poliansky Blash, S, et al. Prevalence and risk factors for acquisition of carbapenem-resistant Enterobacteriaceae in the setting of endemicity. Infect Control Hosp Epidemiol 2013;34:809–817.Google Scholar
17. Ray, MJ, Lin, MY, Weinstein, RA, Trick, WE. Spread of carbapenem-resistant Enterobacteriaceae among Illinois healthcare facilities: the role of patient sharing. Clin Infect Dis 2016;63:889–893.Google Scholar
18. Mathers, AJ, Poulter, M, Dirks, D, Carroll, J, Sifri, CD, Hazen, KC. Clinical microbiology costs for methods of active surveillance for Klebsiella pneumoniae carbapenemase–producing Enterobacteriaceae. Infect Control Hosp Epidemiol 2014;35:350–355.CrossRefGoogle ScholarPubMed
19. Mathers, AJ, Hazen, KC, Carroll, J, et al. First clinical cases of OXA-48-producing carbapenem-resistant Klebsiella pneumoniae in the United States: the “menace” arrives in the new world. J Clin Microbiol 2013;51:680–683.Google Scholar
20. Lewis, JD, Bishop, M, Heon, B, Mathers, AJ, Enfield, KB, Sifri, CD. Admission surveillance for carbapenamase-producing Enterobacteriaceae at a long-term acute care hospital. Infect Control Hosp Epidemiol 2013;34:832–834.Google Scholar
21. Carbapenem-resistant Enterobacteriaceae in healthcare settings. Centers for Disease Control and Prevention website. www.cdc.gov/HAI/organisms/cre/. Updated 2016. Accessed February 22, 2016.Google Scholar
22. Stone, SP, Fuller, C, Savage, J, et al. Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study. BMJ 2012;344:e3005.Google Scholar
Supplementary material: Image

Grabowski et al supplementary material

Grabowski et al supplementary material 1

Download Grabowski et al supplementary material(Image)
Image 226.1 KB