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Statewide Surveillance of Carbapenem-Resistant Enterobacteriaceae in Michigan

Published online by Cambridge University Press:  10 May 2016

Brenda M. Brennan*
Affiliation:
Division of Communicable Diseases, Bureau of Disease Control, Prevention and Epidemiology, Michigan Department of Community Health, Lansing, Michigan
Joseph R. Coyle
Affiliation:
Division of Communicable Diseases, Bureau of Disease Control, Prevention and Epidemiology, Michigan Department of Community Health, Lansing, Michigan
Dror Marchaim
Affiliation:
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, and Sadder School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Jason M. Pogue
Affiliation:
Sinai-Grace Hospital, Detroit, Michigan Division of Infectious Diseases, Detroit Medical Center and Wayne State University, Detroit, Michigan
Martha Boehme
Affiliation:
Bureau of Laboratories, Michigan Department of Community Health, Lansing, Michigan
Jennie Finks
Affiliation:
Division of Communicable Diseases, Bureau of Disease Control, Prevention and Epidemiology, Michigan Department of Community Health, Lansing, Michigan
Anurag N. Malani
Affiliation:
Department of Internal Medicine, Section of Infectious Diseases, Saint loseph Mercy Hospital, Ann Arbor, Michigan
Kerrie E. VerLee
Affiliation:
Infection Prevention and Control, Spectrum Health, Grand Rapids, Michigan
Bryan O. Buckley
Affiliation:
Division of Communicable Diseases, Bureau of Disease Control, Prevention and Epidemiology, Michigan Department of Community Health, Lansing, Michigan
Noreen Mollon
Affiliation:
Division of Communicable Diseases, Bureau of Disease Control, Prevention and Epidemiology, Michigan Department of Community Health, Lansing, Michigan
Daniel R. Sundin
Affiliation:
Department of Laboratories, Spectrum Health, Grand Rapids, Michigan
Laraine L. Washer
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Department of Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
Keith S. Kaye
Affiliation:
Division of Infectious Diseases, Detroit Medical Center and Wayne State University, Detroit, Michigan
*
Surveillance for Healthcare-Associated and Resistant Pathogens Unit, Division of Communicable Diseases, Michigan Department of Community Health, 201 Townsend Street, CVB 5th Floor, Lansing, MI 48913 (brennanb@michigan.gov)

Abstract

Background.

Carbapenem-resistant Enterobacteriaceae (CRE) are clinically challenging, threaten patient safety, and represent an emerging public health issue. CRE reporting is not mandated in Michigan.

Methods.

The Michigan Department of Community Health–led CRE Surveillance and Prevention Initiative enrolled 21 facilities (17 acute care and 4 long-term acute care facilities) across the state. Baseline data collection began September 1, 2012, and ended February 28, 2013 (duration, 6 months). Enrolled facilities voluntarily reported cases of Klebsiella pneumoniae and Escherichia coli according to the surveillance algorithm. Patient demographic characteristics, laboratory testing, microbiology, clinical, and antimicrobial information were captured via standardized data collection forms. Facilities reported admissions and patient-days each month.

Results.

One-hundred two cases over 957,220 patient-days were reported, resulting in a crude incidence rate of 1.07 cases per 10,000 patient-days. Eighty-nine case patients had test results positive for K. pneumoniae, whereas 13 had results positive for E. coli. CRE case patients had a mean age of 63 years, and 51% were male. Urine cultures (61%) were the most frequently reported specimen source. Thirty-five percent of cases were hospital onset; sixty-five percent were community onset (CO), although 75% of CO case patients reported healthcare exposure within the previous 90 days. Cardiovascular disease, renal failure, and diabetes mellitus were the most frequently reported comorbid conditions. Common ris k factors included surgery within the previous 90 days, recent infection or colonization with a multidrug-resistant organism, and recent exposures to antimicrobials, especially third- or fourth-generation cephalosporins.

Conclusions.

CRE are found throughout Michigan healthcare facilities. Implementing a regional, coordinated surveillance and prevention initiative may prevent CRE from becoming hyperendemic in Michigan.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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References

1. Schwaber, MJ, Carmeli, Y. Carbapenem-resistant Enterobacteriaceae: a potential threat. JAMA 2008;300(24):29112913.Google ScholarPubMed
2. Schwaber, MJ, Lev, B, Israeli, A, et al. Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011;52(7):848855.CrossRefGoogle Scholar
3. Canton, R, Akova, M, Carmeli, Y, et al. Rapid evolution and spread of carbapenemases among Enterobacteriaceae in Europe. Clin Microbiol Infect 2012;18(5):413431.CrossRefGoogle Scholar
4. Poirel, L, Pitout, JD, Nordmann, P. Carbapenemases: molecular diversity and clinical consequences. Future Microbiol 2007;2(5):501512.CrossRefGoogle Scholar
5. Cuzon, G, Naas, T, Truong, H, et al. Worldwide diversity of Klebsiella pneumoniae that produce beta-lactamase blaKPC-2 gene. Emerg Infect Dis 2010;16(9):13491356.CrossRefGoogle ScholarPubMed
6. Curcio, DJ. Antibiotic prescription in intensive care units in Latin America. Rev Argent Microbiol 2011;43(3):203211.Google ScholarPubMed
7. Gupta, N, Limbago, BM, Patel, JB, Kallen, AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53(1):6067.CrossRefGoogle Scholar
8. Kitchel, B, Rasheed, JK, Patel, JB, et al. Molecular epidemiology of KPC-producing Klebsiella pneumoniae isolates in the United States: clonal expansion of multilocus sequence type 258. Antimicrob Agents Chemother 2009;53(8):33653370.CrossRefGoogle ScholarPubMed
9. Kitchel, B, Sundin, DR, Patel, JB. Regional dissemination of KPC-producing Klebsiella pneumoniae . Antimicrob Agents Chemother 2009;53(10):45114513.CrossRefGoogle ScholarPubMed
10. Marchaim, D, Chopra, T, Perez, F, et al. Outcomes and genetic relatedness of carbapenem-resistant enterobacteriaceae at Detroit medical center. Infect Control Hosp Epidemiol 2011;32(9):861871.CrossRefGoogle ScholarPubMed
11. Marchaim, D, Chopra, T, Bogan, C, et al. The burden of multidrug-resistant organisms on tertiary hospitals posed by patients with recent stays in long-term acute care facilities. Am J Infect Control 2012;40(8):760765.CrossRefGoogle ScholarPubMed
12. Nordmann, P, Cuzon, G, Naas, T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis 2009;9(4):228236.CrossRefGoogle ScholarPubMed
13. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR Morb Mortal Wkly Rep 2009;58(10):256260.Google ScholarPubMed
14. Gasink, LB, Edelstein, PH, Lautenbach, E, Synnestvedt, M, Fishman, NO. Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae . Infect Control Hosp Epidemiol 2009;30(12):11801185.CrossRefGoogle Scholar
15. Schwaber, MJ, Klarfeld-Lidji, S, Navon-Venezia, S, Schwartz, D, Leavitt, A, Carmeli, Y. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52(3):10281033.CrossRefGoogle ScholarPubMed
16. Marchaim, D, Chopra, T, Pogue, JM, et al. Outbreak of colistin-resistant, carbapenem-resistant Klebsiella pneumoniae in metropolitan Detroit, Michigan. Antimicrob Agents Chemother 2011;55(2):593599.CrossRefGoogle ScholarPubMed
17. Ku, K, Pogue, JM, Moshos, J, et al. Retrospective evaluation of colistin versus tigecycline for the treatment of Acinetobacter baumannii and/or carbapenem-resistant Enterobacteriaceae infections. Am J Infect Control 2012;40(10):983987.CrossRefGoogle ScholarPubMed
18. Borer, A, Saidel-Odes, L, Riesenberg, K, et al. Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia. Infect Control Hosp Epidemiol 2009;30(10):972976.CrossRefGoogle ScholarPubMed
19. Marchaim, D, Navon-Venezia, S, Schwaber, MJ, Carmeli, Y. Isolation of imipenem-resistant Enterobacter species: emergence of KPC-2 carbapenemase, molecular characterization, epidemiology, and outcomes. Antimicrob Agents Chemother 2008;52(4):14131418.CrossRefGoogle Scholar
20. Boucher, HW, Talbot, GH, Bradley, JS, et al. Bad bugs, no drugs: no ESKAPE! an update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48(1):112.CrossRefGoogle ScholarPubMed
21. Peleg, AY, Hooper, DC. Hospital-acquired infections due to gram-negative bacteria. N Engl J Med 2010;362(19):18041813.CrossRefGoogle ScholarPubMed
22. Collins, VL, Marchaim, D, Pogue, JM, et al. Efficacy of ertapenem for treatment of bloodstream infections caused by extended-spectrum-beta-lactamase-producing Enterobacteriaceae. Antimicrob Agents Chemother 2012;56(4):21732177.CrossRefGoogle ScholarPubMed
23. Munoz-Price, LS, Hayden, MK, Lolans, K, et al. Successful control of an outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae at a long-term acute care hospital. Infect Control Hosp Epidemiol 2010;31(4):341347.CrossRefGoogle Scholar
24. Marchaim, D, Chopra, T, Bhargava, A, et al. Recent exposure to antimicrobials and carbapenem-resistant Enterobacteriaceae: the role of antimicrobial stewardship. Infect Control Hosp Epidemiol 2012;33(8):817830.CrossRefGoogle Scholar
25. Bradford, PA, Bratu, S, Urban, C, et al. Emergence of carbapenem-resistant Klebsiella species possessing the class A carbapenem-hydrolyzing KPC-2 and inhibitor-resistant TEM-30 beta-lactamases in New York City. Clin Infect Dis 2004;39(1):5560.CrossRefGoogle Scholar
26. Bratu, S, Landman, D, Haag, R, et al. Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium. Arch Intern Med 2005;165(12):14301435.CrossRefGoogle ScholarPubMed
27. Ben-David, D, Masarwa, S, Navon-Venezia, S, et al. Carbapenem-resistant Klebsiella pneumoniae in post-acute-care facilities in Israel. Infect Control Hosp Epidemiol 2011;32(9):845853.CrossRefGoogle ScholarPubMed
28. Marquez, P, Terashita, D, Dassey, D, Mascola, L. Population-based incidence of carbapenem-resistant Klebsiella pneumoniae along the continuum of care, Los Angeles County. Infect Control Hosp Epidemiol 2013;34(2):144150.CrossRefGoogle ScholarPubMed
29. Chitnis, AS, Caruthers, PS, Rao, AK, et al. Outbreak of carbapenem-resistant enterobacteriaceae at a long-term acute care hospital: sustained reductions in transmission through active surveillance and targeted interventions. Infect Control Hosp Epidemiol 2012;33(10):984992.CrossRefGoogle Scholar
30. 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(12):11931199.CrossRefGoogle ScholarPubMed
31. Shannon, A, Wagner, K, Cheeptham, N, Stephens, G. A pilot survey of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae mediated by K. pneumoniae serine carbapenemases in a regional referral hospital in British Columbia. Can J Infect Dis Med Microbiol 2011;22(2):6163.Google Scholar
32. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement. Wayne, PA: CLSI; 2012. CLSI document M100-S22.Google Scholar
33. Sievert, DM, Boulton, ML, Stoltman, G, et al. Staphylococcus aureus resistant to vancomycin—United States, 2002. MMWR Morb Mortal Wkly Rep 2002;51(26);565567.Google Scholar
34. Finks, J, Wells, E, Dyke, TL, et al. Vancomycin-resistant Staphylococcus aureus, Michigan, USA, 2007. Emerg Infect Dis 2009;15:943945.CrossRefGoogle Scholar
35. Marchaim, D, Perez, P, Lee, J, et al. “Swimming in resistance”: co-colonization with carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii or Pseudomonas aeruginosa . Am J Infect Control 2012;40(9):830835.CrossRefGoogle ScholarPubMed
36. Centers for Disease Control and Prevention (CDC). July 2013 CDC/National Healthcare Safety Network protocol clarifications. http://www.cdc.gov/nhsn/PDFs/pscManual/12pscMDRO_CDADcurrent.pdf. Accessed August 2013.Google Scholar
37. Dellit, TH, Owens, RC, McGowan, JE Jr et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159177.CrossRefGoogle Scholar
38. Carling, P, Fung, T, Killion, A, et al. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol 2003;24(9):699706.CrossRefGoogle Scholar
39. White, AC Jr Atmar, RL, Wilson, J, et al. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis 1997;25:230239.CrossRefGoogle ScholarPubMed
25
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