Infection Control & Hospital Epidemiology (2019), 40, 463–466 doi:10.1017/ice.2019.24
Concise Communication
Laboratory practices for identification and reporting of carbapenem-resistant Enterobacteriaceae in Department of Veterans Affairs facilities
Margaret A. Fitzpatrick MD, MS1,2 , Katie J. Suda PharmD , MS1,3, Swetha Ramanathan MPH1, Marylou Guihan PhD1,4,
Charnetta Brown MA5, Nasia Safdar MD, PhD6,7, Martin Evans MD8, Makoto M. Jones MD, MS9,10, Christopher D. Pfeiffer MD, MHS11,12, J. Stacey Klutts MD, PhD13,14, Michael Icardi MD13,14, Eli Perencevich MD, MS13,15,
Michael Rubin MD, PhD9,10 and Charlesnika T. Evans PhD, MPH1,16 and the QUERI CARRIAGE Program 1Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr, VA Hospital, Hines, Illinois, 2Division of Infectious Diseases, Department of Medicine, Loyola University Stritch School of Medicine, Maywood, Illinois, 3Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois, 4Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 5Department of Veterans Affairs, Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, 6Department of Veterans Affairs, William S. Middleton Memorial VA Medical Center, Madison, Wisconsin, 7Department of Medicine, Division of Infectious Diseases, University of Wisconsin School of Public Health and Medicine, Madison, Wisconsin, 8Department of Veterans Affairs, Lexington VA Medical Center, Lexington, Kentucky, 9Department of Veterans Affairs, VA Salt Lake City Healthcare System, Salt Lake City, Utah, 10Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, Utah, 11Department of Veterans Affairs, Portland VA Healthcare System, Portland, Oregon, 12Division of Infectious Diseases, Department of Medicine, Oregon Health Science University, Portland, Oregon, 13Department of Veterans Affairs, Iowa City VA Health Care System, Iowa City, Iowa, 14Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, 15Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa and 16Center for Healthcare Studies and Department of Preventive Medicine Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Abstract
Laboratory identification of carbapenem-resistant Enterobacteriaceae (CRE) is a key step in controlling its spread. Our survey showed that most Veterans Affairs laboratories follow VA guidelines for initial CRE identification, whereas 55.0% use PCR to confirm carbapenemase production. Most respondents were knowledgeable about CRE guidelines. Barriers included staffing, training, and financial resources.
(Received 15 October 2018; accepted 13 January 2019)
Carbapenem-resistantEnterobacteriaceae (CRE) are difficult-to-treat multidrug-resistant organisms (MDROs) associated with high morbidity and mortality.1 Laboratory identification of CRE and determining whether CRE produce a carbapenemase (CP-CRE) are critical to controlling spread because they help facilitate timely implementation of infection control (IC) measures. Laboratory practices regarding CRE have evolved, with newer molecular tech- niques being more accurate for identifying CP-CRE compared to phenotypic tests; however, cost and limited availability of timely molecular testing limit widespread implementation. Recently, the Department of Veterans Affairs (VA) distributed
the VHA 2017 Guideline for Control of Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE).2 This guide- line updates a prior 2015 guideline and addresses changes in the col- lection of surveillance specimens, specific microorganisms to be assessed, and definitions of resistance. The 2017 VA guideline also
Author for correspondence: Margaret A. Fitzpatrick, Email:
Margaret.fitzpatrick@va. gov Cite this article: Fitzpatrick MA, et al. (2019). Laboratory practices for identification
and reporting of carbapenem-resistant Enterobacteriaceae in Department of Veterans Affairs facilities. Infection Control & Hospital Epidemiology, 40: 463–466, https://
doi.org/10.1017/ice.2019.24
includes algorithms to standardize CRE screening, identification, and reporting. Although the VA 2017 guideline is similar to guide- lines issued by the Centers for Disease Control and Prevention (CDC),3 key differences exist, most notably the CDC’sinclusion of ertapenem in the antibiotic susceptibility criteria for the CRE definition.4 Few data exist on current laboratory practices for CRE/CP-CRE identification and reporting. This study describes findings from a national survey on laboratory practices regarding CRE in VA facilities after distribution of the 2017 guideline.
Methods
A cross-sectional electronic survey was distributed from June 26, 2017 to November 2, 2017, to laboratory and/or microbiology supervisors at 152 VA medical centers (VAMCs). Subsequent e-mail reminders were targeted to 129 VAMCs that provide inpatient acute care to veterans. Surveys were completed by laboratory personnel who were knowledgeable about the imple- mentation of CRE guidelines at their facility. Respondents were encouraged to consult colleagues if needed. The survey was developed by study team members using guid- ance from prior survey studies on CRE5 and with input from the
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
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