1482. Visualizations to Improve Regional Situational Awareness of Carbapenem-Resistant Enterobacteriaceae (CRE) Among Healthcare Professionals
Session: Poster Abstract Session: HAI: Surveillance and Public Reporting
Friday, October 28, 2016
Room: Poster Hall
  • Morrell_IDWeek_Final_20161003.pdf (1.9 MB)
  • Background: Carbapenem-resistant Enterobacteriaceae (CRE) are an urgent threat with mortality rates of up to 40%. Meaningful visualizations of CRE and carbapenemase-producing CRE (CP-CRE) are needed for situational awareness among healthcare facility and public health staff involved in a regional approach to prevention.

    Methods: Data were obtained from the state surveillance system. US Census Bureau population estimates 2015 were used for denominators. A pre-webinar survey was used to request feedback on sample maps depicting fictional CRE data.  Data was displayed using different time intervals and stratified by organism. Final maps were discussed at a Focus Group Webinar. Participants included infection preventionists, laboratory, pharmacy, local/regional public health staff, and physicians.  All maps were created using ArcMap 10.3.1 (Esri, CA). 

    Results: Figure 1 shows annual incidence rates of CRE by county of residence.  The group preferred maps showing annual incidence rates, updated every 6 months, overlaid by gradient bubbles showing number of infections within the last 30 and 90 days (see Figure 2 for KPC producers). Due to monthly fluctuations in case counts, the group suggested that the minimum time-frame for displaying incidence rates was per quarter (see Figure 3) displaying annualized incidence rates per quarter for Enterobacter spp.  Group members wanted maps to show boundaries of Emergency Management System (EMS) regions because these reflect catchment areas.   In addition to these maps, group members wanted tables listing number of CRE and CP-CRE cases (KPC and novel) both by state of residence and healthcare facility where CRE were identified in last 30 and 90 days, to be updated monthly.

    Conclusion: Hosting a focus group aided immensely in determining optimal ways to present CRE and CP-CRE data to health professionals in Tennessee to provide regional situational awareness. 

    Figure 1. Incidence Rates of CRE (Klebsiella spp, E. coli, Enterobacter spp) per 100,000 by County of Residence, TN 2015

    Figure 2. Incidence rates for 2015 by county of residence and number of cases in the last 30 and 90 days as of March 31, 2016.

    Figure 3. Annualized quarterly incidence rates per 100,000 by county of residence for KPC +ve Enterobacter spp in 2015, by quarter. 

    Casey Morrell, MPH, Rebecca Meyer, MPH, Raphaelle Beard, MPH, Daniel Muleta, MD, MPH, Loretta Moore-Moravian, RN/BSN, COHN-S/CM and Marion Kainer, MBBS, MPH, FSHEA, Tennessee Department of Health, Nashville, TN


    C. Morrell, None

    R. Meyer, None

    R. Beard, None

    D. Muleta, None

    L. Moore-Moravian, None

    M. Kainer, 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.