Utility of Carbapenem-Resistant Enterobacteriaceae Surveillance Cultures in Predicting Clearance of Colonization
Methods: In April 2009, our institution began surveillance perirectal cultures for detection of CRE colonization for high-risk patients and those epidemiologically linked to CRE-infected or colonized patients. All patients with a positive perirectal culture obtained between April 2009 and August 2013 were included in this study. Results of follow-up perirectal cultures to assess for ongoing colonization, as well as subsequent clinical isolates, were evaluated. Recurrence of CRE-positivity was defined as a positive perirectal culture or clinical culture, following at least one negative perirectal culture.
Results: During the study period, 142 patients were found to be perirectally colonized with CRE. Fifty-one of 95 (53.7%) patients with at least one follow-up perirectal culture were negative for CRE colonization at the first follow-up culture. After one negative CRE perirectal culture, 24 of 31 patients (77.4%) with a subsequent culture remained negative. After two consecutive negative CRE perirectal cultures, 17 of 20 patients (85.0%) with a subsequent culture remained negative. After three consecutive negative CRE perirectal cultures, six of eight patients (75.0%) remained CRE-negative on all subsequent cultures for the duration of the study. Two patients had recurrence of CRE after at least three consecutive negative cultures.
Conclusion: Our institution’s experience with CRE surveillance demonstrates that CRE colonization is prolonged and can be detected intermittently; thus any routine practice of using surveillance cultures to discontinue contact precautions may be associated with an unacceptably high risk of relapse and exposure of other patients to these highly resistant pathogens.
A. Mathers, None
E. Giannetta, None
C. D. Sifri, None
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