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

OBJECTIVE

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.

DESIGN

Point-prevalence study.

SETTING

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.

PATIENTS

Inpatients on all units excluding psychiatry and obstetrics-gynecology.

METHODS

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.

RESULTS

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.

CONCLUSION

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 8 , August 2017 , pp. 921 - 929
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

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

References

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