338.   Carbapenem-Resistant Enterobacteriaceae (CRE) and Antimicrobial Usage within the Veterans Affairs (VA) Healthcare System: 2010-2014
Session: Poster Abstract Session: HAI: Multi Drug Resistant Gram Negatives
Thursday, October 27, 2016
Room: Poster Hall

Background:  Although still relatively infrequent, CRE has spread and is found throughout the United States and worldwide.  To date, reports describing the distribution of CRE within healthcare systems are limited.  Our objective is to describe the incidence and distribution of CRE and antimicrobial use in VA over a 5-year period (2010-2014).

Methods:  CRE were isolated in VA using standard microbiologic methods.  VA databases were queried for all isolates of Enterobacteriaceae from 1/1/2010-12/31/2014 meeting Centers for Disease Control and Prevention CRE criteria1.  Only isolates from the first CRE culture from a patient were included in calculating incidence and distribution based on US Census Regions.  VA databases were queried for barcode medication administration data of cephalosporins, beta-lactam/beta-lactamase inhibitors, and carbapenems from 1/1/2008-12/31/2014 and presented as days of therapy per 1000 beds days of care by US Census Regions and all VA.

Results:  There were 2300 patients with a positive CRE culture (Table 1).  CRE was present in all regions.  Overall, there was no difference in rates for each of the five years.  Of the regions, Other (Puerto Rico) had the highest number; West had the least.  Klebsiella species was most frequently isolated (62%), and urine was the most common specimen site (61%).  In all VA, beta-lactam/beta-lactamase inhibitors were used more than cephalosporins and carbapenems; usage rates were stable over time.  Usage rates for all 3 antimicrobial types were highest in the Other (Puerto Rico) and lowest in the Northeast region for all five years with no difference over time (Figure 1).

Conclusion:  CRE was consistently present in VA with some regional variation in numbers and trends over five years.  Broad-spectrum antimicrobial use was relatively unchanged over time.  The highest CRE rates and antimicrobial usage were observed in Puerto Rico.

1CDC. Vital Signs:  carbapenem-resistant enterobacteriaceae.  MMWR 2013;62(9):165-170.


Russell Ryono, Pharm. D.1, Gina Oda, MS1, Patricia Schirmer, MD2, Cynthia Lucero-Obusan, MD1 and Mark Holodniy, MD, FIDSA, FSHEA1, (1)Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, CA, (2)Office of Public Health, Department of Veterans Affairs, Washington, DC


R. Ryono, None

G. Oda, None

P. Schirmer, None

C. Lucero-Obusan, None

M. Holodniy, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.