Program Schedule

355
Carbapenem-Resistant Enterobacteriaceae (CRE) Distribution within the Veterans Affairs Healthcare System:  2013

Session: Poster Abstract Session: Multidrug-resistant Organisms: Epidemiology and Prevention
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: The Centers for Disease Control (CDC) has reported national trends for hospital-acquired infections with CRE.  Utilizing the Department of Veteran’s Affairs (VA) Healthcare-Associated Infections and Influenza Surveillance System (HAIISS), we sought to describe isolation of CRE among Veterans cared for nationally at inpatient and outpatient VA healthcare settings from January - December 2013.

Methods: We queried the HAIISS Data Warehouse for all isolates of Enterobacteriaceae meeting CDC criteria:

  • Nonsusceptible to one of the following carbapenems: doripenem, meropenem, or imipenem AND
  • Resistant to all of the following third-generation cephalosporins that were tested: ceftriaxone, cefotaxime, and ceftazidime.

CRE were isolated in VA using standard microbiologic methods. Duplicate isolates were eliminated unless they were isolated in more than one specimen type category.

Results: A total of 528 unique isolates meeting CDC criteria for the one year time period were isolated (Table 1). Klebsiella (64%) and Enterobacter (16%) species were most common. The primary specimen types associated with CRE were urine, respiratory, and blood, with 359 (58%), 102 (16%), and 53 (9%) isolates respectively.  The remaining 106 (17%) CRE isolates were from a variety of other specimen types. 

Table 1:  Breakdown of CRE isolates by Genus and U.S. Census region plus Puerto Rico

Bacterial Genus

Northeast

Midwest

South

West

Puerto Rico

Total

Citrobacter

9

2

3

4

3

21

Enterobacter/Pantoea

12

6

31

20

18

87

Escherichia

2

4

14

4

6

30

Klebsiella/Raotella

104

36

75

20

101

336

Morganella

6

2

1

2

2

13

Proteus

5

9

9

6

0

29

Providencia

0

0

0

1

0

1

Serratia

1

0

3

0

7

11

Total

139

59

136

57

137

528

Conclusion: CRE distribution in VA healthcare settings nationally is similar to that reported by CDC[1], with the largest number of isolates occurring in the Northeast and South. VA did have a higher number of CRE isolates in Puerto Rico compared to that reported by CDC. Consistent with other reports, CRE was isolated most frequently from urine. CRE is emerging as a significant concern in VA.



[1] MMWR March 8, 2013/62(09);165-170 Vital Signs: Carbapenem-Resistant Enterobacteriaceae

Russell Ryono, Pharm. D., Gina Oda, MS, Gayathri Shankar, MS, Patricia Schirmer, MD and Mark Holodniy, MD, Office of Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, CA

Disclosures:

R. Ryono, None

G. Oda, None

G. Shankar, None

P. Schirmer, None

M. Holodniy, None

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