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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

Published online by Cambridge University Press:  15 June 2017

Jacqueline Reuben*
Department of Health, Washington, DC
Nancy Donegan
District of Columbia Hospital Association, Washington, DC
Glenn Wortmann
Section of Infectious Diseases, MedStar Washington Hospital Center, Washington, DC
Roberta DeBiasi
Division of Pediatric Infectious Diseases, Children’s National Medical Center, Washington, DC
Xiaoyan Song
Office of Infection Control/Epidemiology, Children’s National Medical Center, Washington, DC
Princy Kumar
Division of Infectious Diseases and Travel Medicine, MedStar Georgetown University Hospital, Washington, DC
Mary McFadden
Infection Control Department, MedStar Georgetown University Hospital, Washington, DC
Sylvia Clagon
Infectious Disease/Infection Control Department, United Medical Center, Washington, DC
Janet Mirdamadi
Infection Prevention and Control Department, Bridgepoint Hospital National Harbor, Washington, DC
Diane White
Administration Department, Bridgepoint Hospital National Harbor, Washington, DC
Jo Ellen Harris
Infection Control Department, Sibley Memorial Hospital, Washington, DC
Angella Browne
Infection Control Department, Howard University Hospital, Washington, DC
Jane Hooker
Quality Department, Providence Health System, Washington, DC
Michael Yochelson
Medical Affairs Department, MedStar National Rehabilitation Hospital, Washington, DC
Milena Walker
Infection Prevention Department, George Washington University Hospital, Washington, DC
Gary Little
Infection Prevention Department, George Washington University Hospital, Washington, DC
Gail Jernigan
Administration Department, Transitions Healthcare Capitol City, Washington, DC
Kathleen Hansen
Infection Control/Prevention Department, BridgePoint Hospital Capitol Hill, Washington, DC
Brenda Dockery
Infection Control/Prevention Department, BridgePoint Hospital Capitol Hill, Washington, DC
Brendan Sinatro
District of Columbia Hospital Association, Washington, DC
Morris Blaylock
DC Department of Forensic Sciences – Public Health Laboratory, Washington, DC
Kimary Harmon
DC Department of Forensic Sciences – Public Health Laboratory, Washington, DC
Preetha Iyengar
Department of Health, Washington, DC
Trevor Wagner
OpGen, Gaithersburg, Maryland
Jo Anne Nelson
District of Columbia Hospital Association, Washington, DC
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 (



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

Original Articles
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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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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