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Regional transmission patterns of carbapenemase-producing Enterobacterales: A healthcare network analysis

Published online by Cambridge University Press:  22 April 2022

Bekana K. Tadese ,
Kayo Fujimoto Open the ORCID record for Kayo Fujimoto [Opens in a new window] ,
Stacia M. DeSantis ,
Osaro Mgbere  and
Charles Darkoh Open the ORCID record for Charles Darkoh [Opens in a new window]
Bekana K. Tadese
Affiliation:
School of Public Health, University of Texas Health Science Center, Houston, Texas Fort Bend County Health and Human Services, Texas
Kayo Fujimoto
Affiliation:
School of Public Health, University of Texas Health Science Center, Houston, Texas
Stacia M. DeSantis
Affiliation:
School of Public Health, University of Texas Health Science Center, Houston, Texas
Osaro Mgbere
Affiliation:
Disease Prevention and Control Division, Houston Health Department, Houston, Texas Institute of Community Health, University of Houston College of Pharmacy, Houston, Texas
Charles Darkoh*
Affiliation:
School of Public Health, University of Texas Health Science Center, Houston, Texas MD Anderson Cancer Center University of Texas Health Graduate School of Biomedical Sciences, Microbiology, and Infectious Diseases Program, Houston, Texas
*
Author for correspondence: Charles Darkoh, E-mail: Charles.Darkoh@uth.tmc.edu
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Abstract

Objective:

Carbapenem-resistant Enterobacterales (CRE) pose a serious public health threat and spread rapidly between healthcare facilities (HCFs) during interfacility patient movement. We examined patterns of transmission of CRE associated with network clustering and positions during patient interfacility transfer.

Methods:

A retrospective cohort study was conducted in the Greater Houston region ofTexas, , and social network analysis was performed by constructing facility-to-facility patient transfer network using CRE surveillance data. The network method (community detection algorithm) was used to detect clustering patterns of CRE in the network. In addition, network measures of centrality and local connectivity (clustering coefficient) were computed for each healthcare facility. Zero-inflated negative binomial regression analysis was applied to test the association between network measures and facility-specific incidence rate of CRE.

Results:

A network of 268 healthcare facilities was identified, in which 10 acute-care hospitals (ACHs) alone accounted for 63% of identified CRE cases. Transmission of New Delhi metallo-β-lactamase–producing CRE occurred in 3 clusters, yet all cases were traced to patients who had had medical care abroad. The incidence rate of CRE attributed to ACHs was >4-fold (adjusted rate ratio, 4.5; 95% confidence interval [CI], 3.02–6.72) higher than that of long-term care facilities. Each additional patient shared with another HCF conferred a 3% (95% CI, 2%–4%) increase in the incidence rate of CRE at that HCF.

Conclusions:

The incidence rates of CRE at a given HCF was predicted by the healthcare network metrics. Increased surveillance and selective targeting of high-risk facilities are warranted.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 3 , March 2023 , pp. 453 - 459
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Van Duin, D, Doi, Y. The global epidemiology of carbapenemase-producing Enterobacteriaceae. Virulence 2017;8:460–469.10.1080/21505594.2016.1222343CrossRefGoogle ScholarPubMed
Woodworth, KR, Walters, MS, Weiner, LM, et al. Vital signs: containment of novel multidrug-resistant organisms and resistance mechanisms—United States, 2006–2017. Morb Mortal Wkly Rep 2018;67:396–401.10.15585/mmwr.mm6713e1CrossRefGoogle ScholarPubMed
Gupta, N, Limbago, BM, Patel, JB, Kallen, AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53:60–67.10.1093/cid/cir202CrossRefGoogle ScholarPubMed
Antibiotic resistance threats in the United States, 2019. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf. Published 2019. Accessed April 8, 2022.Google Scholar
Bonomo, RA, Burd, EM, Conly, J, et al. Carbapenemase-producing organisms: a global scourge. Clin Infect Dis 2018;66:1290–1297.10.1093/cid/cix893CrossRefGoogle ScholarPubMed
Yan, Z, Zhou, Y, Du, M, et al. Prospective investigation of carbapenem-resistant Klebsiella pneumonia transmission among the staff, environment and patients in five major intensive care units, Beijing. J Hosp Infect 2019;101:150–157.10.1016/j.jhin.2018.11.019CrossRefGoogle ScholarPubMed
Kotsanas, D, Wijesooriya, WR, Korman, TM, et al. “Down the drain”: carbapenem-resistant bacteria in intensive care unit patients and handwashing sinks. Med J Aust 2013;198:267–269.10.5694/mja12.11757CrossRefGoogle ScholarPubMed
Huang, SS, Avery, TR, Song, Y, et al. Quantifying interhospital patient sharing as a mechanism for infectious disease spread. Infect Control Hosp Epidemiol 2010;31:1160–1169.10.1086/656747CrossRefGoogle ScholarPubMed
Simmering, JE, Polgreen, LA, Campbell, DR, Cavanaugh, JE, Polgreen, PM. Hospital transfer network structure as a risk factor for Clostridium difficile infection. Infect Control Hosp Epidemiol 2015;36:1031–1037.10.1017/ice.2015.130CrossRefGoogle ScholarPubMed
Sreeramoju, P, Montie, B, Ramirez, AM, Ayeni, A. Healthcare-associated infection: a significant cause of hospital readmission. Infect Control Hosp Epidemiol 2010;31:1195–1197.10.1086/656746CrossRefGoogle ScholarPubMed
Emerson, CB, Eyzaguirre, LM, Albrecht, JS, Comer, AC, Harris, AD, Furuno, JP. Healthcare-associated infection and hospital readmission. Infect Control Hosp Epidemiol 2012;33:539–544.CrossRefGoogle ScholarPubMed
Shimasaki, T, Segreti, J, Tomich, A, et al. Active screening and interfacility communication of carbapenem-resistant Enterobacteriaceae (CRE) in a tertiary-care hospital. Infect Control Hosp Epidemiol 2018;39:1058–1062.10.1017/ice.2018.150CrossRefGoogle ScholarPubMed
Barbadoro, P, Dichiara, A, Arsego, D, et al. Klebsiella pneumoniae in hub and spoke connected health-care networks: a case study from Italy. Microorganisms 2020;8:37.10.3390/microorganisms8010037CrossRefGoogle Scholar
Campos, AC, Albiero, J, Ecker, AB, et al. Outbreak of Klebsiella pneumoniae carbapenemase-producing K pneumoniae: a systematic review. Am J Infect Control 2016;44:1374–1380.CrossRefGoogle ScholarPubMed
CDC. Carbapenem-resistant Klebsiella pneumoniae associated with a long-term care facility—West Virginia, 2009–2011. Morb Mortal Wkly Rep 2011;60:1418–1420.Google Scholar
Reuben, J, Donegan, N, Wortmann, G, et al. Healthcare Antibiotic Resistance Prevalence–DC (HARP-DC): a regional prevalence assessment of carbapenem-resistant Enterobacteriaceae (CRE) in healthcare facilities in Washington, District of Columbia. Infect Control Hosp Epidemiol 2017;38:921–929.10.1017/ice.2017.110CrossRefGoogle ScholarPubMed
Slayton, RB, Toth, D, Lee, BY, et al. Vital signs: estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in healthcare facilities—United States. Morb Mortal Wkly Rep 2015;64:826–831.10.15585/mmwr.mm6430a4CrossRefGoogle ScholarPubMed
Population Estimates. US Census Bureau website. https://www.census.gov/programs-surveys/popest.html. Accessed October 10, 2021.Google Scholar
Borgatti, SP, Everett, MG, Freeman, LC. 2002. UCINET 6 for Windows: Software for Social Network Analysis. Harvard, MA: Analytic Technologies.Google Scholar
Bastian, M, Heymann, S, Jacomy, M. Gephi: an open source software for exploring and manipulating networks. Third International AAAI Conference on Weblogs and Social media. Demonstration papers; 2009;3(1).CrossRefGoogle Scholar
Andry, A, Budi, R. Community detection methods in social network analysis. J Comput Theoret Nanosci 2014;20:250–253.Google Scholar
Munoz-Price, LS. Long-term acute-care hospitals. Clin Infect Dis 2009;49:438–443.CrossRefGoogle ScholarPubMed
Prabaker, K, Lin, MY, McNally, M, et al. Transfer from high-acuity long-term care facilities is associated with carriage of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae: a multihospital study. Infect Control Hosp Epidemiol 2012;33:1193–1199.CrossRefGoogle ScholarPubMed
O’Fallon, E, Gautam, S, D’Agata, EM. Colonization with multidrug-resistant gram-negative bacteria: prolonged duration and frequent cocolonization. Clin Infect Dis 2009;48:1375–1381.10.1086/598194CrossRefGoogle ScholarPubMed
Won, SY, Munoz-Price, LS, Lolans, K, et al. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2011;53:532–540.10.1093/cid/cir482CrossRefGoogle ScholarPubMed
Epstein, L, Hunter, JC, Arwady, MA, et al. New Delhi metallo-β-lactamase–producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA 2014;312:1447–1455.10.1001/jama.2014.12720CrossRefGoogle Scholar
CDC. Notes from the Field: New Delhi metallo-β-lactamase-producing Escherichia coli associated with endoscopic retrograde cholangiopancreatography—Illinois, 2013. Morb Mortal Wkly Rep 2014;62:1051.Google Scholar
Safavi, M, Bostanshirin, N, Hajikhani, B, et al. Global genotype distribution of human clinical isolates of New Delhi metallo-β-lactamase–producing Klebsiella pneumoniae: a systematic review. J Glob Antimicrob Resist 2020;23:420–429.10.1016/j.jgar.2020.10.016CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
McKinnell, JA, Miller, LG, Singh, RD, et al. High prevalence of multidrug-resistant organism colonization in 28 nursing homes: an “iceberg effect.” J Am Med Dir Assoc 2020;21:1937–1943.CrossRefGoogle ScholarPubMed