312. Healthcare Antibiotic Resistance Prevalence - DC (HARP-DC); Measuring the Prevalence of vanA Genes in Healthcare Facilities (HCF) in Washington DC
Session: Poster Abstract Session: HAI: MSSA, MRSA, and other Gram-Positives
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • 312_IDWk_vanA.pdf (880.9 kB)
  • Background: Infection and colonization with vancomycin-resistant Enterococci (VRE) are common in HCFs. Approximately 40% of Enterococcal healthcare-associated infections (HAIs) reported to the National Healthcare Safety Network from DC are resistant to vancomycin; VRE colonization prevalence rates were unknown. Contact Precautions (CP) for VRE, recommended by the Centers for Disease Control and Prevention, are increasingly controversial because of relatively low pathogenicity, growing prevalence, negative effects of isolation, and conflicting evidence about isolation effectiveness.

    Methods: The HARP-DC study measured the prevalence of carbapenem-resistant Enterobacteriaceae in DC HCFs; samples were also evaluated for the vanA gene associated with VRE using the Acuitas® MDRO Gene test (OpGen). We assessed 2,216 patients from 16 HCFs (all 8 acute care hospitals (AH); 1 inpatient rehabilitation hospital (IRH), and 7 long term care facilities (LTCF). LTCFs included 5 skilled nursing facilities (SNF) and 2 long term acute care facilities (LTAC)). A total of 1021 patients met inclusion criteria and consented to participate.

    Results: Overall VRE point prevalence was 26.4%. Prevalence rates (PR) for AHs, LTCFs, and the IRH were 26.8, 29.5, and 7.7, respectively. The PR for the IRH was significantly lower than other HCFs, and lower than expected, based on the vancomycin resistance rate among HAIs in DC (p <0.01, p<0.01respectively).

    Prevalence vanA

    Prevalence Ratio (PR) and Confidence Interval (CI) Comparing Location Type to Total

    Location

    Type

    n HCFs

    n patients

    targeted

    n samples

    % sampled

    n vanA

    % vanA

    Range % vanA

    vanA

    PR

     

    PR

    CI

    AH

    8

    1580

    725

    45.9

    194

    26.8

    0.0-45.6

    1.0

    0.9-1.2

    LTCF

    7

    543

    244

    44.8

    72

    29.5

    0.0-74.4

    1.2

    0.9-1.5

    RH

    1

    93

    52

    55.9

    4

    7.7

    -

    0.3

    0.1-0.8

    p<0.01

    Total

    16

    2216

    1021

    46.1

    270

    26.4

    0.0-74.4

    -

    -

    Conclusion: Over a quarter of inpatients in DC HCFs were colonized with VRE, as measured by the prevalence of the vanA gene. DC HCFs may now use these data to evaluate current prevention approaches, including the use of active surveillance and/or CP, and design a collaborative, regional framework for prevention that creates consistency across facilities with individualized implementation based on facility and patient type.

    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

    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.