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Active screening and interfacility communication of carbapenem-resistant Enterobacteriaceae (CRE) in a tertiary-care hospital

  • Teppei Shimasaki (a1), John Segreti (a1), Alexander Tomich (a2), Julie Kim (a1), Mary K. Hayden (a1), Michael Y. Lin (a1) and for the CDC Prevention Epicenters Program (a1) (a2)...



Hospitals may implement admission screening cultures and may review transfer documentation to identify patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) to implement isolation precautions; however, outcomes and logistical considerations have not been well described.


At an academic hospital in Chicago, we retrospectively studied the implementation and outcomes of CRE admission screening from 2013 to 2016 during 2 periods. During period 1, we implemented active CRE rectal culture screening for all adults patients admitted to intensive care units (ICUs) and for those transferred from outside facilities to general wards. During period 2, screening was restricted only to adults transferred from outside facilities. For a subset of transferred patients who were previously reported to the health department as CRE positive, we reviewed transfer paperwork for appropriate documentation of CRE.


Overall, 11,757 patients qualified for screening; rectal cultures were performed for 8,569 patients (73%). Rates of CRE screen positivity differed by period, previous facility type (if transferred), and current inpatient location. A higher combined CRE positivity rate was detected in the medical and surgical ICUs among period 2 patients (3.3%) versus all other ward-period comparisons (P<.001). Among 13 transferred patients previously known to be CRE colonized, appropriate CRE transfer documentation was available for only 4 patients (31%).


Active screening for CRE is feasible, and screening patients transferred from outside facilities to the medical or surgical ICU resulted in the highest screen positivity rate. Furthermore, CRE carriage was inconsistently documented in transfer paperwork, suggesting that admission screening or enhanced inter-facility communication are needed to improve the identification of CRE-colonized patients.


Corresponding author

Address for correspondence: Teppei Shimasaki, MD, MS, 600 S Paulina St, Suite 143, Chicago, IL 60612. E-mail: or Michael Y. Lin MD, MPH, 600 S Paulina St, Suite 143, Chicago, IL 60612. E-mail:


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1. Borer, A, Saidel-Odes, L, Riesenberg, K, et al. Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia. Infect Control Hosp Epidemiol 2009;30:972976.
2. Patel, G, Huprikar, S, Factor, SH, Jenkins, SG, Calfee, DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008;29:10991106.
3. Okamoto, K, Lin, MY, Haverkate, M, et al. Modifiable risk factors for the spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae among long-term acute-care hospital patients. Infect Control Hosp Epidemiol 2017;38:670677.
4. Snitkin, ES, Zelazny, AM, Thomas, PJ, et al. Tracking a hospital outbreak of carbapenem-resistant Klebsiella pneumoniae with whole-genome sequencing. Sci Transl Med 2012;4:148ra116.
5. Epstein, L, Hunter, JC, Arwady, MA, et al. New Delhi metallo-beta-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA 2014;312:14471455.
6. Schechner, V, Kotlovsky, T, Tarabeia, J, et al. Predictors of rectal carriage of carbapenem-resistant Enterobacteriaceae (CRE) among patients with known CRE carriage at their next hospital encounter. Infect Control Hosp Epidemiol 2011;32:497503.
7. 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;33:11931199.
8. Centers for Disease Control and Prevention (CDC). Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR Morb Mortal Wkly Rep 2009;58:256260.
9. Ben-David, D, Maor, Y, Keller, N, et al. Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection. Infect Control Hosp Epidemiol 2010;31:620626.
10. Kochar, S, Sheard, T, Sharma, R, et al. Success of an infection control program to reduce the spread of carbapenem-resistant Klebsiella pneumoniae . Infect Control Hosp Epidemiol 2009;30:447452.
11. Calfee, D, Jenkins, SG. Use of active surveillance cultures to detect asymptomatic colonization with carbapenem-resistant Klebsiella pneumoniae in intensive care unit patients. Infect Control Hosp Epidemiol 2008;29:966968.
12. National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion. Facility guidance for control of carbapenem-resistant Enterobacteriaceae (CRE), November 2015 update—CRE toolkit. Centers for Disease Control and Prevention website. Published 2012. Accessed June 11, 2018.
13. Hayden, MK, Lin, MY, Lolans, K, et al. Prevention of colonization and infection by Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae in long-term acute-care hospitals. Clin Infect Dis 2015;60:11531161.
14. Lin, MY, Froilan, MC, Lolans, K, et al. The importance of ventilator skilled nursing facilities (vSNFs) in the regional epidemiology of carbapenemase-producing organisms (CPOs). Open Forum Infect Dis 2017;4:S137S138.
15. Lin, MY, Lyles-Banks, RD, Lolans, K, et al. The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2013;57:12461252.
16. Prabaker, KK, Hayden, MK, Weinstein, RA, Lin, MY, CDC Prevention Epicenter Program. Use of the point of origin code from a universal billing form, UB-04, to efficiently identify hospitalized patients admitted from other health care facilities. Am J Infect Control 2012;40:659662.
17. Witteck, A, Rettenmund, G, Schlegel, M. MRSA admission screening in a low prevalence setting—Much ado about nothing? Swiss Med Wkly 2011;141:w13217.
18. Trick, WE, Lin, MY, Cheng-Leidig, R, et al. Electronic public health registry of extensively drug-resistant organisms, Illinois, USA. Emerg Infect Dis 2015;21:17251732.
19. Lolans, K, Calvert, K, Won, S, Clark, J, Hayden, MK. Direct ertapenem disk screening method for identification of KPC-producing Klebsiella pneumoniae and Escherichia coli in surveillance swab specimens. J Clin Microbiol 2010;48:836841.
20. Mangold, KA, Santiano, K, Broekman, R, et al. Real-time detection of blaKPC in clinical samples and surveillance specimens. J Clin Microbiol 2011;49:33383339.
21. Rasheed, JK, Kitchel, B, Zhu, W, et al. New Delhi metallo-beta-lactamase-producing Enterobacteriaceae, United States. Emerg Infect Dis 2013;19:870878.
22. Cole, JM, Schuetz, AN, Hill, CE, Nolte, FS. Development and evaluation of a real-time PCR assay for detection of Klebsiella pneumoniae carbapenemase genes. J Clin Microbiol 2009;47:322326.
23. Lin, MY, Rezny, S, Ray, MJ, et al. Predicting carbapenem-resistant enterobacteriaceae (CRE) carriage at the time of admission using a state-wide hospital discharge database. Open Forum Infect Dis 2016;3:S348.
24. Banach, DB, Bearman, G, Barnden, M, et al. Duration of contact precautions for acute-care settings. Infect Control Hosp Epidemiol 2018;39:127144.
25. Ho, KW, Ng, WT, Ip, M, You, JH. Active surveillance of carbapenem-resistant enterobacteriaceae in intensive care units: Is it cost-effective in a nonendemic region? Am J Infect Control 2016;44:394399.


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