2373. Healthcare Antibiotic Resistance Prevalence – DC (HARP - DC)- Measuring the Prevalence of Carbapenem Resistant Enterobacteriaceae in Healthcare Facilities (HCF) in Washington DC
Session: Oral Abstract Session: Epidemiology and Outcomes of Resistant Gram-Negative Organisms
Saturday, October 29, 2016: 2:00 PM
Room: 388-390

 

Background: CDC has labeled CRE as an URGENT public health threat and encouraged states to implement a coordinated community approach for control. DC does not require healthcare facilities to report CRE, so the prevalence of infection and colonization of this antibiotic-resistant threat was unknown.  A collaborative of HCFs coordinated by the DC Department of Health (DC-DOH), the Public Health Laboratory and the DC Hospital Association conducted a point prevalence study to determine a baseline.

Methods: In total, 2,216 patients from 16 participating HCFs [all 8 acute care hospitals (AH); 5 skilled nursing facilities (SNF); 2 long term acute care facilities (LTAC); and 1 inpatient rehabilitation hospital (IRH)] were assessed for study inclusion.  Of those, 1,021 perianal swabs were obtained from patients who consented and met inclusion criteria.  Samples were evaluated for 10 antibiotic resistance genes, using Acuitas® MDRO Gene Test (OpGen) and culture. Samples positive for CRE-associated genes (KPC, NDM, or OXA 48) or with carbapenem-resistance were considered CRE.  Results were delivered in real time to facilities using the Acuitas Lighthouse™ MDRO Management System. 

Results: Overall CRE prevalence was 5.1%; 4.8% for AH, and 7.0% for Long Term Care Facilities (LTCF), including SNFs and LTAC (Table 1). There was one identical DNA-based profile found in multiple patients within a single HCF, and other profiles were found across multiple HCFs (Figure 1).  NDM and OXA-48 resistance was found in one sample each. The rate was highest in those aged 20-39; lowest in the very young and very old (Figure 2).

Table 1

CRE Prevalence – Percent Positve by Location Type

Location

Type

n facilities

n patients

targetted

n samples

% sampled

n

CRE

% CRE

Range % CRE

HCF

16

2216

1021

46.1

52

5.1

0.0-29.4

               AH

8

1580

725

15.9

35

4.8

0.0-7.7

                              AH ICU

8

270

90

33.3

6

6.7

0.0-11.6

                              AH Wards

8

1180

574

48.6

28

4.9

0.0-9.3

               LTCF

7

543

244

44.8

17

7.0

0.8-29.4

               RH

1

93

52

55.9

0

0.0

-

Conclusion: CRE colonization was found to be endemic with the highest rates in LTCFs and ICU settings.  Potential instances of CRE transmission were identified within and across facilities.  A wide variation in prevalence rates support the need for institutional-specific bundled prevention programs and regional collaboration.

 

Jacqueline Reuben, MHS1, Nancy Donegan, MPH2, Jo Anne Nelson, DC3, Brendan Sinatro, MPH3, Morris Blaylock, Ph.D.4 and Kimary Harmon, MBA, MPH5, (1)Center for Policy, Planning and Evaluation, DC Department of Health, Washington, DC, (2)District of Columbia Hospital Association, Alexandria, VA, (3)District of Columbia Hospital Association, Washington, DC, (4)Washington DC Public Health Laboratory, Department of Forensic Sciences, Washington, DC, (5)Public Health Laboratory, Department of Forensic Science, Washington, DC

Disclosures:

J. Reuben, None

N. Donegan, OpGen: Collaborator , Research support

J. A. Nelson, None

B. Sinatro, OpGen: Collaborator , Research support

M. Blaylock, None

K. Harmon, None

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