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

作者：Reuben Jacqueline; Donegan Nancy; Wortmann Glenn; DeBiasi Roberta; Song Xiaoyan; Kumar Princy; McFadden Mary; Clagon Sylvia; Mirdamadi Janet; White Diane; Harris Jo Ellen; Browne Angella; Hooker Jane; Yochelson Michael; Walker Milena; Little Gary; Jernigan Gail; Hansen Kathleen; Dockery Brenda; Sinatro Brendan; Blaylock Morris; Harmon Kimary; Iyengar Preetha; Wagner Trevor; Nelson Jo Anne

来源：Infection Control and Hospital Epidemiology, 2017, 38(8): 921-929.

DOI：10.1017/ice.2017.110

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;38:921-929

• 出版日期2017-8