Capacity Building within the Microbiology Laboratory is Needed to Ensure Implementation of Strategies to Control the Spread of CRE

Background:

Carbapenem-resistant Enterobacteriaceae (CRE) represent an urgent threat to patient safety and public health across the United States and in California. Centers for Disease Control and Prevention strategies for CRE containment in healthcare facilities include screening epidemiologically-linked contacts of previously unrecognized CRE patients to evaluate for transmission, and as part of active surveillance strategies. Carbapenemase-producing CRE (CP-CRE) are prioritized for these interventions. We assessed capacity of California hospital microbiology laboratories to support CRE surveillance and control strategies.

Methods:

The California Antimicrobial Resistance Laboratory Network Assessment (CARLA) was a cross-sectional, voluntary survey targeted to microbiology staff among acute care hospitals in California. Non-respondents were contacted by phone to improve response rates. Respondents were asked to classify the laboratory capacity to screen rectal swab specimens for CRE, and to test CRE isolates for the presence of carbapenemases. Hospital beds and patient volume data were obtained from National Healthcare Safety Network 2015 Annual Survey.

Results:

CARLA included 264 (67%) hospitals representing 75% of hospital beds in the state. Respondents were directors n=165, clinical scientists n=97, and infection preventionists n=2. Among 178 (67%) hospitals reporting access to CRE screening tests, 157 (88%) use the hospital lab and 21 (12%) use a referral lab; 85 (48%) hospitals capable of performing CRE screening tests on-site would require additional time to obtain supplies and assess quality control, including 39 that would require >2 weeks. Among 182 (69%) hospitals reporting access to carbapenemase testing, 115 (44%) use the modified Hodge test, 43 (16%) use polymerase chain reaction (PCR), and 7 (3%) use the Carba NP assay. 

Conclusion:

Microbiology laboratories play a critical role in the response to CRE. State and local public health can provide education to assist hospitals laboratories in building local capacity to ensure implementation of CRE prevention strategies; an evaluation of public health laboratory capacity to supplement clinical laboratories in CRE screening and carbapenemase testing is ongoing.