1405. 2011 Carbapenem-Resistant Enterobacteriaceae (CRE) Survey in Maryland Acute Care Hospitals
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Background: : In 2011, Maryland Department of Health and Mental Hygiene (DHMH) performed a second annual CRE prevalence survey to evaluate the changing epidemiology of CRE in Maryland. In 2010, a statewide laboratory survey of CRE prevalence in acute hospitals was performed.

Methods: A concise survey was disseminated to all Maryland clinical laboratories serving acute hospitals to determine the number of unduplicated patients testing positive for CRE from 9/1/10-8/31/11.  This survey was adapted from a 2009-10 survey to address CRE prevalence, laboratory techniques and guidelines defining CRE, notification protocols for positive CRE, and existence of electronic queries for CRE results.

Results: Overall, 35/42 queried laboratories responded. Data collected for the 2011 CRE prevalence survey revealed 269 CRE-positive cases from 36 reporting hospitals (21 clinical laboratories). This reflected a 26% decrease from the total number of 2009-10 cases reported. Positive cases ranged from 0-63 per facility. Seven facilities (20%) reported no CRE. The highest case-counts were 27 and 63 from two large urban hospitals.  CRE frequency distribution was 0-5 cases in 19 (54%) facilities, 6-15 in 14 (40%) facilities, and 16-68 in 2 (6%) facilities. The median CRE count was 3, the mean 8 and the mode 0. Of 35 reporting facilities, 26 had responded to the 2009-2010 survey:  Comparison among these 26 facilities showed that geographic distribution, case-count per facility, overall mean, median and mode were similar across the two year time span. Clinical laboratories revealed a variety of techniques, guidelines and protocols for identifying CRE (data not shown).

Conclusion: Relative to baseline 2009-10 data, Maryland CRE cases continue to be widely distributed; these findings emphasize the need to customize prevention strategies based on CRE prevalence and epidemiology in individual facilities. Prevalence rates may be affected by the variation in laboratory techniques for diagnosing CRE, including adoption of newer Minimum Inhibitory Concentration breakpoints and other changing technology.   Maryland will continue to explore methods to improve laboratory participation, such as employing public health epidemiologists in electronic queries of laboratory data and considering the implementation of mandatory CRE reporting.

Michael McAllaster1,2, Malorie Givan, MPH3, Patricia Lawson, RN, MPH, CIC4, Lucy Wilson, MD5, David Blythe, MD, MPH5, Jafar Razeq, PhD3, Katie Richards, MPH3 and Brenda Roup, PhD, RN5, (1)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (2)Infectious Disease Epidemiology and Outbreak Response, Maryland Department of Health and Mental Hygiene, Baltimore, MD, (3)MD Department of Health and Mental Hygiene, Baltimore, MD, (4)Johns Hopkins Medical Institutions, Baltimore, MD, (5)Maryland Department of Health and Mental Hygiene, Baltimore, MD

Disclosures:

M. McAllaster, None

M. Givan, None

P. Lawson, None

L. Wilson, None

D. Blythe, None

J. Razeq, None

K. Richards, None

B. Roup, None

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