Infection Control & Hospital Epidemiology (2018), 39, 1491–1493 doi:10.1017/ice.2018.236
Concise Communication
How frequently are hospitalized patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) already on contact precautions for other indications?
Katherine E. Goodman JD1, Patricia J. Simner MSc, PhD2, Eili Y. Klein PhD1,3,4, Abida Q. Kazmi MS2, Avinash Gadala MS, BPharma5, Clare Rock MD, MS5,6, Pranita D. Tamma MD, MHS7, Sara E. Cosgrove MD, MS, FSHEA5,6, Lisa L. Maragakis MD, MPH5,6 and Aaron M. Milstone MD MHS1,5,7, for the CDC Prevention Epicenters
Program and the CDC MIND-Healthcare Program 1Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, 2Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, 3Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, 4The Center for Disease Dynamics, Economics and Policy, Washington, DC, 5Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland, 6Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland and 7Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Abstract
Using samples collected for VRE surveillance, we evaluated unit admission prevalence of carbapenem-resistant Enterobacteriaceae (CRE) perirectal colonization and whether CRE carriers (unknown to staff) were on contact precautions for other indications. CRE colonization at unit admission was infrequent (3.9%). Most CRE carriers were not on contact precautions, representing a reservoir for healthcare- associated CRE transmission.
(Received 30 May 2018; accepted 19 August 2018; electronically published October 1, 2018)
Carbapenem-resistant Enterobacteriaceae (CRE) represent an urgent antibiotic resistance threat.1 The Centers for Disease Control and Prevention (CDC) recommends contact isolation precautions for CRE colonized or infected patients to limit healthcare-associated transmission.2 Most US inpatient facilities, however, do not perform routine screening to detect CRE. Our objective was to measure the prevalence of CRE perirectal colo- nization upon hospital unit admission (results unknown to clin- ical staff) and to evaluate whether CRE carriers were already on contact precautions for other indications at the time of unit entry.
Methods Study setting and population
This study included adults admitted to the Johns Hopkins Hospital (JHH) medical intensive care unit (MICU) or solid organ transplant unit (transplant unit) betweenMay 1, 2016, and July 1, 2017. Both units have a longstanding vancomycin-
Authors for correspondence: Katherine E. Goodman JD, 615 N. Wolfe Street,
Baltimore, MD 21205. E-mail:
Kgoodma7@jhu.edu. Aaron Milstone MD, MHS, 200 N Wolfe Street, Rubenstein 3141, Baltimore, MD 21287. E-mail:
AMilsto1@jhmi.edu Cite this article: Goodman KE, et al. (2018). How frequently are hospitalized patients
colonized with carbapenem-resistant Enterobacteriaceae (CRE) already on contact precautions for other indications? Infection Control & Hospital Epidemiology 2018, 39, 1491–1493. doi: 10.1017/ice.2018.236
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
resistant Enterococcus (VRE) surveillance program and collect admission perirectal Eswabs (Copan Diagnostics, Murrieta, CA) from patients.
Microbiology methods
Residual Amies media was stored at 4°C and, within 4 days of swab collection, directly plated onto MacConkey agar with erta- penem and meropenem disks.3 Colonies growing within 27mmof ertapenem and 32 mm of meropenem were identified using matrix-assisted laser-desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS, Bruker Daltonics). Carbapenem antimicrobial susceptibility testing (ie, ertapenem, meropenem, and imipenem) was performed by disk diffusion applying Clinical and Laboratory Standards Institute guidelines.4 Enterobacteriaceae resistant to ertapenem, meropenem, and/or imipenem were categorized as CRE. CRE-positive isolates were tested for carba- penemase production (CP-CRE) using the modified carbapenem inactivation method (mCIM).5 CRE status was deidentified until study completion and blinded to clinical and infection control staff.
Infection control data collection
Infection control databases were queried to identify patients placed on contact precautions at unit admission because of a
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