Six Months of Surveillance for Carbapenem-Resistant Enterobacteriaceae in Maryland
To make data comparable across states, this analysis was limited to non-duplicate patients and to CRE meeting the CDC’s surveillance definition (nonsusceptible to doripenem, imipenem or meropenem by most recent CLSI carbapenem breakpoints and resistant to all third-generation cephalosporins tested).
Maryland laboratories reported 134 CRE between November 7, 2013 and April 30, 2014, representing disease and/or colonization occurring in acute care hospitals, long term acute care hospitals and long term care facilities. The majority of cases (60%) occurred in patients residing in the Baltimore Metro Area (BMA) but rates per 100,000 residents were similar for the BMA (2.94) , Southern Maryland (2.83) and the Eastern Shore (2.87) (Figure 1). Residents of the National Capital Region (NCR) and Western Maryland experienced lower rates (1.35 and 0.79 respectively). More than half of cases were isolated from urine but cases were reported from a variety of body sites including sterile sources (Figure 2). Klebsiella pneumoniae was the most frequently reported organism (Figure 3) but cases occurred in 15 separate species of Enterobacteriaceae. Most cases (58%) occurred in adults over 65 years of age; another 36% occurred in adults aged 35-64 and the remaining 6% were from adults aged 18-34. No pediatric cases were reported.
Statewide surveillance has shown that CRE is well-established in Maryland. Surveillance data does not differentiate between symptomatic infection and colonization, but it is reasonable to assume that some CRE in urine is colonization only. Given this limitation and recognizing that urine may be a frequent source of transmission, physicians and infection preventionists must carefully consider how to manage CRE in urine. Maryland’s antibiotic stewardship efforts must also emphasize reducing unnecessary antibiotic use across healthcare settings to reduce the threat of CRE.
L. E. Wilson, None
K. Richards, None
J. Razeq, None
D. Jain, None
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