How introducing a registry with automated alerts for carbapenem-resistant enterobacteriaceae (CRE) may help control CRE spread in a region

Bruce Y. Lee, Sarah M. Bartsch, Mary K. Hayden, Joel Welling, Jay V. DePasse, Sarah K. Kemble, Jim Leonard, Robert A. Weinstein, Leslie E. Mueller, Kruti Doshi, Shawn T. Brown, William E. Trick, Michael Y. Lin

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Regions are considering the use of electronic registries to track patients who carry antibiotic-resistant bacteria, including carbapenem-resistant Enterobacteriaceae (CRE). Implementing such a registry can be challenging and requires time, effort, and resources; therefore, there is a need to better understand the potential impact. Methods. We developed an agent-based model of all inpatient healthcare facilities (90 acute care hospitals, 9 long-term acute care hospitals, 351 skilled nursing facilities, and 12 ventilator-capable skilled nursing facilities) in the Chicago metropolitan area, surrounding communities, and patient flow using our Regional Healthcare Ecosystem Analyst software platform. Scenarios explored the impact of a registry that tracked patients carrying CRE to help guide infection prevention and control. Results. When all Illinois facilities participated (n = 402), the registry reduced the number of new carriers by 11.7% and CRE prevalence by 7.6% over a 3-year period. When 75% of the largest Illinois facilities participated (n = 304), registry use resulted in a 11.6% relative reduction in new carriers (16.9% and 1.2% in participating and nonparticipating facilities, respectively) and 5.0% relative reduction in prevalence. When 50% participated (n = 201), there were 10.7% and 5.6% relative reductions in incident carriers and prevalence, respectively. When 25% participated (n = 101), there was a 9.1% relative reduction in incident carriers (20.4% and 1.6% in participating and nonparticipating facilities, respectively) and 2.8% relative reduction in prevalence. Conclusions. Implementing an extensively drug-resistant organism registry reduced CRE spread, even when only 25% of the largest Illinois facilities participated due to patient sharing. Nonparticipating facilities garnered benefits, with reductions in new carriers.

Original languageEnglish (US)
Pages (from-to)843-849
Number of pages7
JournalClinical Infectious Diseases
Volume70
Issue number5
DOIs
StatePublished - Mar 1 2020

Keywords

  • CRE
  • Electronic registry
  • Modeling
  • Transmission

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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