Healthcare Antibiotic Resistance Prevalence – DC (HARP - DC)- Measuring the Prevalence of Carbapenem Resistant Enterobacteriaceae in Healthcare Facilities (HCF) in Washington DC

 

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.