Program Schedule

364
Utility of Carbapenem-Resistant Enterobacteriaceae Surveillance Cultures in Predicting Clearance of Colonization

Session: Poster Abstract Session: Multidrug-resistant Organisms: Epidemiology and Prevention
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • CPE clearance poster - Jessica Lewis.pdf (666.9 kB)
  • Background: The Centers for Disease Control and Prevention recommends that institutions in which carbapenem-resistant Enterobacteriaceae(CRE) is endemic perform active surveillance testing and maintain contact precautions for CRE-colonized or infected patients, however, does not provide guidance regarding discontinuation of contact precautions for these patients.  Here we review our institution’s CRE surveillance program to determine the utility of serial screening in predicting clearance of CRE 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.

    Jessica Lewis, MD1, Kyle Enfield, MD MS2, Amy Mathers, MD1, Eve Giannetta, RN, BSN, CIC3 and Costi D. Sifri, MD4, (1)Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, VA, (2)Department of Medicine, Division of Pulmonology, Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, VA, (3)Infection Prevention and Control, University of Virginia Health System, Charlottesville, VA, (4)Department of Medicine, Division of Infectious Diseases and International Health, Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, VA

    Disclosures:

    J. Lewis, None

    K. Enfield, None

    A. Mathers, None

    E. Giannetta, None

    C. D. Sifri, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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