Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-17T15:07:02.187Z Has data issue: false hasContentIssue false
  • English
  • Français

Establishment of a Statewide Network for Carbapenem-Resistant Enterobacteriaceae Prevention in a Low-Incidence Region

Published online by Cambridge University Press:  10 May 2016

Christopher D. Pfeiffer ,
Margaret C. Cunningham ,
Tasha Poissant ,
Jon P. Furuno ,
John M. Townes ,
Andrew Leitz ,
Ann Thomas ,
Genevieve L. Buser ,
Robert F. Arao  and
Zintars G. Beldavs
Christopher D. Pfeiffer*
Affiliation:
Department of Hospital and Specialty Medicine, Portland Veterans Affairs Medical Center, Portland, Oregon Department of Medicine, Oregon Health and Science University, Portland, Oregon
Margaret C. Cunningham
Affiliation:
Oregon Public Health Division, Oregon Health Authority, Portland, Oregon
Tasha Poissant
Affiliation:
Oregon Public Health Division, Oregon Health Authority, Portland, Oregon
Jon P. Furuno
Affiliation:
Oregon State University/Oregon, Health and Science University College of Pharmacy, Portland, Oregon
John M. Townes
Affiliation:
Department of Hospital and Specialty Medicine, Portland Veterans Affairs Medical Center, Portland, Oregon
Andrew Leitz
Affiliation:
Department of Medicine, Oregon Health and Science University, Portland, Oregon
Ann Thomas
Affiliation:
Oregon Public Health Division, Oregon Health Authority, Portland, Oregon
Genevieve L. Buser
Affiliation:
Oregon Public Health Division, Oregon Health Authority, Portland, Oregon
Robert F. Arao
Affiliation:
Oregon Public Health Division, Oregon Health Authority, Portland, Oregon
Zintars G. Beldavs
Affiliation:
Oregon Public Health Division, Oregon Health Authority, Portland, Oregon
*
Portland Veterans Affairs Medical Center, PO Box 1034 P3-ID, Portland, OR 97239 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To establish a statewide network to detect, control, and prevent the spread of carbapenem-resistant Enterobacteriaceae (CRE) in a region with a low incidence of CRE infection.

Design.

Implementation of the Drug Resistant Organism Prevention and Coordinated Regional Epidemiology (DROP-CRE) Network.

Setting and Participants.

Oregon infection prevention and microbiology laboratory personnel, including 48 microbiology laboratories, 62 acute care facilities, and 140 long-term care facilities.

Methods.

The DROP-CRE working group, comprising representatives from academic institutions and public health, convened an interdisciplinary advisory committee to assist with planning and implementation of CRE epidemiology and control efforts. The working group established a statewide CRE definition and surveillance plan; increased the state laboratory capacity to perform the modified Hodge test and polymerase chain reaction for carbapenemases in real time; and administered surveys that assessed the needs and capabilities of Oregon infection prevention and laboratory personnel. Results of these inquiries informed CRE education and the response plan.

Results.

Of 60 CRE reported from November 2010 through April 2013, only 3 were identified as carbapenemase producers; the cases were not linked, and no secondary transmission was found. Microbiology laboratories, acute care facilities, and long-term care facilities reported lacking carbapenemase testing capability, reliable interfacility communication, and CRE awareness, respectively. Survey findings informed the creation of the Oregon CRE Toolkit, a state-specific CRE guide booklet.

Conclusions.

A regional epidemiology surveillance and response network has been implemented in Oregon in advance of widespread CRE transmission. Prospective surveillance will determine whether this collaborative approach will be successful at forestalling the emergence of this important healthcare-associated pathogen.

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. 356 - 361
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Gupta, N, Limbago, BM, Patel, JB, Kallen, AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53(1):60–67.CrossRefGoogle ScholarPubMed
2. Nordmann, P, Naas, T, Poirel, L. Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2011;17(10):1791–1798.CrossRefGoogle ScholarPubMed
3. Yigit, H, Queenan, AM, Anderson, GJ, et al. Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae . Antimicrob Agents Chemother 2001;45(4):1151–1161.CrossRefGoogle ScholarPubMed
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(148):148ra116.CrossRefGoogle ScholarPubMed
5. 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(12):1099–1106.CrossRefGoogle ScholarPubMed
6. Smith, DL, Dushoff, J, Perencevich, EN, Harris, AD, Levin, SA. Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: resistance is a regional problem. Proc Natl Acad Sci USA 2004;101(10):3709–3714.CrossRefGoogle ScholarPubMed
7. 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(6):532–540.CrossRefGoogle ScholarPubMed
8. 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):848–855.CrossRefGoogle Scholar
9. Centers for Disease Control and Prevention. Long-term care assessment tool. http://www.cdc.gov/HAI/toolkits/LTC_Assessment_tool_final.pdf. Accessed November 1, 2012.Google Scholar
10. Centers for Disease Control and Prevention. Guidance for control of carbapenem-resistant Enterobacteriaceae (CRE): 2012 CRE toolkit, http://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf. Accessed August 15, 2013.Google Scholar
11. Oregon Health Authority. Guidance for control of carbapenem-resistant Enterobacteriaceae (CRE): 2013 Oregon toolkit. http://public.health.oregon.gov/DiseasesConditions/DiseasesAZ/CRE. Accessed August 15, 2013.Google Scholar
12. Patel, G, Bonomo, RA. “Stormy waters ahead:” global emergence of carbapenemases. Front Microbiol 2013;4:48.CrossRefGoogle ScholarPubMed
13. Barnes, SL, Harris, AD, Golden, BL, Wasil, EA, Furuno, JP. Contribution of interfacility patient movement to overall methicillin-resistant Staphylococcus aureus prevalence levels. Infect Control Hosp Epidemiol 2011;32(11):1073–1078.CrossRefGoogle ScholarPubMed
14. The Joint Commission. 2013 comprehensive accreditation manual for hospitals: infection prevention and control standard IC.02.01.01. Oak Brook, IL: Joint Commission Resources, 2013:IC-8–IC-9.Google Scholar
15. Council of State and Territorial Epidemiologists. Communication of possible healthcare-associated infections across health-care settings. Position statement 13-ID-09. 2013.Google Scholar
16. Roup, BJ, Scaletta, JM. How Maryland increased infection prevention and control activity in long-term care facilities, 2003–2008. Am J Infect Control 2011;39(4):292–295.CrossRefGoogle ScholarPubMed
17. Gamage, B, Schall, V, Grant, J, Group PIL-tCNAW. Identifying the gaps in infection prevention and control resources for long-term care facilities in British Columbia. Am J Infect Control 2012;40(2):150–154.CrossRefGoogle ScholarPubMed
18. Roup, BJ, Roche, JC, Pass, M. Infection control program disparities between acute and long-term care facilities in Maryland. Am J Infect Control 2006;34(3):122–127.CrossRefGoogle ScholarPubMed
19. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing. Twenty-second informational supplement. CLSI document M100-S22. Wayne, PA: CLSI, 2012.Google Scholar