1577. Pilot Testing of an Out-of-Country Medical Care Questionnaire with Screening and Cost Analysis of Pre-emptive Isolation for Carbapenem-resistant Enterobacteriaceae in a Large Canadian Health Region
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • CRE Screening Poster - ID Week (final).pdf (1.7 MB)
  • Background: The spread of carbapenem-resistant Enterobacteriaceae (CRE) is an important public health concern. A key risk factor for CRE acquisition is the receipt of out-of-country medical care (OCMC). Prompt identification and isolation of patients with CRE has significant resource implications. We sought to determine the proportion of admitted patients in our health region who received OCMC in the previous 12 months, assess their CRE colonization status and estimate the cost associated with a pre-emptive isolation strategy.

    Methods: A screening OCMC questionnaire was developed and piloted at four hospitals from 17/07/12- 05/09/12. The questionnaire inquired about location and type (inpatient vs. outpatient) of OCMC and was administered by the clerk or nurse at the time of admission. Screening for CRE colonization was done by rectal swab or stool sample using CHROMagar™ KPC screening media. Costs (Bank of Canada 2013 inflation adjusted) for pre-emptive isolation were extrapolated from previously published data on resistant gram-negatives in a large Canadian hospital (Conterno, J Hosp Inf 2007).

    Results: Over the 2 month study period there were 13 835 admissions. Screening questionnaires were administered to 6646 patients (48%).  Out of all patients screened 206 (3.1%) were found to have received OCMC. Outpatient visits comprised 59%, 18% were inpatient hospitalizations, and 16% had both types of care. The most common locations were the United States (34%), Asia (23%), Europe (15%) and Central/South America (11%). CRE screening samples were obtained for 101 patients (49%). No patients were colonized with CRE. Extrapolating to a full year yielded 2573 OCMC recipients requiring pre-emptive isolation at a cost of $2 380 025/year ($925/patient isolated). The cost of isolating only recipients of inpatient OCMC would be $809 375/year.  

    Conclusion: With increasing rates of travel and medical tourism more patients are receiving OCMC. Though this point-prevalence study did not identify any CRE colonized patients, ongoing surveillance and stringent infection control practices will be critical for identifying and limiting the spread of CRE amongst hospitalized patients in Canada. A pre-emptive isolation strategy has significant resource implications and is not practical at this time.

    Nipunie Rajapakse, MD1, Joseph Vayalumkal, MD1, Debbie Lam-Li2, Craig Pearce, M.Sc2, Gwynne Rees, M.Sc3, Linda Kamhuka, M.Sc3, Gisele Peirano, PhD4, Corrinne Pidhorney5, Karen Hope, MSc6, Daniel Gregson, MD4, Johann Pitout, MD4, Thomas Louie, MD7 and John Conly, MD7, (1)Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada, (2)Infection Prevention and Control, Foothills Medical Center, Calgary, AB, Canada, (3)Infection Prevention and Control, Alberta Children's Hospital, Calgary, AB, Canada, (4)Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada, (5)Infection Prevention and Control, Rockyview General Hospital, Calgary, AB, Canada, (6)Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada, (7)Foothills Medical Center, University of Calgary, Calgary, AB, Canada


    N. Rajapakse, None

    J. Vayalumkal, None

    D. Lam-Li, None

    C. Pearce, None

    G. Rees, None

    L. Kamhuka, None

    G. Peirano, None

    C. Pidhorney, None

    K. Hope, None

    D. Gregson, None

    J. Pitout, None

    T. Louie, None

    J. Conly, None

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