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Statewide Surveillance of Carbapenem-Resistant Enterobacteriaceae in Michigan

Published online by Cambridge University Press:  10 May 2016

Brenda M. Brennan ,
Joseph R. Coyle ,
Dror Marchaim ,
Jason M. Pogue ,
Martha Boehme ,
Jennie Finks ,
Anurag N. Malani ,
Kerrie E. VerLee ,
Bryan O. Buckley  and
Noreen Mollon
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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)
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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
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 4: Special Topic Issue: Carbapenem-Resistant Enterobacteriaceae and Multidrug-Resistant Organisms , April 2014 , pp. 342 - 349
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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