Healthcare Antibiotic Resistance Prevalence - DC (HARP-DC): A Regional Prevalence Assessment of Carbapenem-Resistant Enterobacteriaceae (CRE) in Healthcare Facilities in Washington, District of Columbia.

MedStar author(s):
Citation: Infection Control & Hospital Epidemiology. 38(8):921-929, 2017 AugPMID: 28615088Institution: MedStar National Rehabilitation Network | MedStar Washington Hospital CenterDepartment: Medicine/Infectious DiseasesForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *beta-Lactam Resistance | *Carbapenems/tu [Therapeutic Use] | *Cross Infection/ep [Epidemiology] | *Enterobacteriaceae Infections/ep [Epidemiology] | *Enterobacteriaceae/de [Drug Effects] | Adult | Aged | Aged, 80 and over | Cross Infection/dt [Drug Therapy] | District of Columbia/ep [Epidemiology] | Enterobacteriaceae Infections/dt [Drug Therapy] | Female | Hospitals/sn [Statistics & Numerical Data] | Humans | Male | Middle Aged | Nursing Homes/sn [Statistics & Numerical Data] | Prevalence | Real-Time Polymerase Chain Reaction | Skilled Nursing Facilities/sn [Statistics & Numerical Data] | Young AdultYear: 2017Local holdings: Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0899-823X
Name of journal: Infection control and hospital epidemiologyAbstract: 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;1-9.All authors: Blaylock M, Browne A, Clagon S, DeBiasi R, Dockery B, Donegan N, Hansen K, Harmon K, HARP Study Team, Harris JE, Hooker J, Iyengar P, Jernigan G, Kumar P, Little G, McFadden M, Mirdamadi J, Nelson JA, Reuben J, Sinatro B, Song X, Wagner T, Walker M, White D, Wortmann G, Yochelson MFiscal year: FY2017Digital Object Identifier: Date added to catalog: 2017-06-16
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 28615088 Available 28615088

Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006

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;1-9.

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