The potential trajectory of carbapenem-resistant enterobacteriaceae, an emerging threat to health-care facilities, and the impact of the centers for disease control and prevention toolkit

Bruce Lee, Sarah Bartsch, Kim F. Wong, James A. McKinnell, Rachel B. Slayton, Loren G. Miller, Chenghua Cao, Diane S. Kim, Alexander J. Kallen, John A. Jernigan, Susan S. Huang

Research output: Contribution to journalArticle

Abstract

Carbapenem-resistant Enterobacteriaceae (CRE), a group of pathogens resistant to most antibiotics and associated with high mortality, are a rising emerging public health threat. Current approaches to infection control and prevention have not been adequate to prevent spread. An important but unproven approach is to have hospitals in a region coordinate surveillance and infection control measures. Using our Regional Healthcare Ecosystem Analyst (RHEA) simulation model and detailed Orange County, California, patient-level data on adult inpatient hospital and nursing home admissions (2011-2012), we simulated the spread of CRE throughout Orange County health-care facilities under 3 scenarios: no specific control measures, facility-level infection control efforts (uncoordinated control measures), and a coordinated regional effort. Aggressive uncoordinated and coordinated approaches were highly similar, averting 2,976 and 2,789 CRE transmission events, respectively (72.2% and 77.0% of transmission events), by year 5. With moderate control measures, coordinated regional control resulted in 21.3% more averted cases (n = 408) than did uncoordinated control at year 5. Our model suggests that without increased infection control approaches, CRE would become endemic in nearly all Orange County health-care facilities within 10 years. While implementing the interventions in the Centers for Disease Control and Prevention's CRE toolkit would not completely stop the spread of CRE, it would cut its spread substantially, by half.

Original languageEnglish (US)
Pages (from-to)471-479
Number of pages9
JournalAmerican Journal of Epidemiology
Volume183
Issue number5
DOIs
StatePublished - Mar 1 2016

Fingerprint

Carbapenems
Health Facilities
Enterobacteriaceae
Centers for Disease Control and Prevention (U.S.)
Infection Control
Delivery of Health Care
Facility Regulation and Control
Nursing Homes
Ecosystem
Inpatients
Public Health
Anti-Bacterial Agents
Mortality

Keywords

  • carbapenem-resistant Enterobacteriaceae
  • control measures
  • coordinated responses
  • regional spread
  • surveillance

ASJC Scopus subject areas

  • Epidemiology

Cite this

The potential trajectory of carbapenem-resistant enterobacteriaceae, an emerging threat to health-care facilities, and the impact of the centers for disease control and prevention toolkit. / Lee, Bruce; Bartsch, Sarah; Wong, Kim F.; McKinnell, James A.; Slayton, Rachel B.; Miller, Loren G.; Cao, Chenghua; Kim, Diane S.; Kallen, Alexander J.; Jernigan, John A.; Huang, Susan S.

In: American Journal of Epidemiology, Vol. 183, No. 5, 01.03.2016, p. 471-479.

Research output: Contribution to journalArticle

Lee, Bruce ; Bartsch, Sarah ; Wong, Kim F. ; McKinnell, James A. ; Slayton, Rachel B. ; Miller, Loren G. ; Cao, Chenghua ; Kim, Diane S. ; Kallen, Alexander J. ; Jernigan, John A. ; Huang, Susan S. / The potential trajectory of carbapenem-resistant enterobacteriaceae, an emerging threat to health-care facilities, and the impact of the centers for disease control and prevention toolkit. In: American Journal of Epidemiology. 2016 ; Vol. 183, No. 5. pp. 471-479.
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