1401. Active Surveillance for Carbapenem-resistant Enterobacteriaceae (CRE) Using Stool Specimens Submitted for Clostridium difficile Testing
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Background: Active surveillance (AS) using perianal swab sampling to identify asymptomatic carriers of CRE may reduce transmission of CRE in healthcare settings.  Given similar risk factors for Clostridium difficile infection and CRE colonization, a potential alternative to perianal sampling is the use of stool specimens submitted for C. difficile testing. The objectives of this study were to determine the prevalence of CRE colonization among hospitalized patients tested for C. difficile, assess the effectiveness of this AS strategy, and describe characteristics of CRE-colonized patients identified using this strategy.

Methods: Stool specimens submitted for C. difficile testing at two academic medical centers in New York City were tested for CRE. As part of an ongoing CRE control program, Hospital A also performed AS in adult ICUs using perianal swab sampling. No other AS was performed in Hospital B. A nested case-control study was performed to identify factors associated with CRE carriage among patients tested for C. difficile.

Results: CRE was isolated from 27 (2.6%) of 1,047 specimens.  The overall prevalence of CRE was 2.9% (25/854 unique patients).  Isolates included 23 K. pneumoniae, 1 K. oxytoca, and 1 E. cloacae.  Of the CRE-positive patients, 10 (40%) were previously known to be CRE-colonized (64% at Hospital A versus 21% at Hospital B, p=0.049).  The cost of detecting one new CRE-colonized patient ranged from $580 (Hospital B) to $649 (Hospital A).  There were no significant differences in CRE colonization rates by study site, gender, or C. difficile test result.  In bivariate analysis, factors associated with CRE carriage (p<0.05) included length of stay, days of antibiotic therapy and admission from a nursing home prior to CRE testing.   

Conclusion: AS using stool specimens submitted for C. difficile testing identified patients with previously unrecognized CRE carriage.  This strategy may have greatest yield in facilities in which AS in high-risk populations (e.g., ICUs) is not performed.  This study also identified other factors (length of stay, duration of antibiotic therapy, nursing home residence) that may be of use in designing higher yield, risk factor-based AS strategies.  Risk factor-based AS strategies should be further evaluated in larger studies and other settings.

David Banach, MD, MPH1, Jeannette Francois, MT2, Stephanie Blash, MPH3, Gopi Patel, MD, MS1, Stephen Jenkins, PhD4, Vincent LaBombardi, PhD3, Arjun Srinivasan, MD, FSHEA5 and David P. Calfee, MD, MS, FSHEA6, (1)Mount Sinai School of Medicine, New York, NY, (2)New York Presbyterian Hospital, New York, NY, (3)Mount Sinai Hospital, New York, NY, (4)Cornell Medical College, New York, NY, (5)Centers for Disease Control and Prevention, Atlanta, GA, (6)Weill Cornell Medical College, New York, NY


D. Banach, None

J. Francois, None

S. Blash, None

G. Patel, None

S. Jenkins, None

V. LaBombardi, None

A. Srinivasan, None

D. P. Calfee, None

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