Effect of varying federal definitions on prevalence and characteristics associated with carbapenem-resistant Enterobacteriaceae in veterans with spinal cord injury - 31/01/19
, Katie J. Suda, PharmD, MS a, c, Makoto M. Jones, MD d, e, Stephen P. Burns, MD f, g, Linda Poggensee, MS a, Swetha Ramanathan, MPH a, Martin Evans, MD h, i, j, Charlesnika T. Evans, PhD, MPH a, kHighlights |
• | Patients with spinal cord injury have high carbapenem-resistant Enterobacteriaceae (CRE) prevalence as opposed to the general population. |
• | Variability in federal surveillance definitions affects CRE prevalence. |
• | Inclusion of ertapenem resistance in the definition leads to higher CRE prevalence. |
• | Almost all CRE was isolated from high-complexity, urban Department of Veterans Affairs medical centers. |
Résumé |
Background |
Patients with spinal cord injury (SCI) have a high risk for multidrug-resistant organisms, including carbapenem-resistant Enterobacteriaceae (CRE). Accurate and easily applied definitions are critical to identify CRE. This study describes CRE and associated characteristics in veterans with SCI per Centers for Disease Control and Prevention (CDC) and Department of Veterans Affairs (VA) definitions.
Methods |
A retrospective cohort of veterans with SCI and more than 1 culture with Escherichia coli, Klebsiella spp and/or Enterobacter spp between 2012 and 2013 was examined. Antibiotic susceptibility criteria of pre-2015 (CDC1) and post-2015 (CDC2) CDC definitions and pre-2017 (VA1) and post-2017 (VA2) VA definitions were used to identify CRE. CRE prevalence and characteristics are described for isolates meeting each definition, and agreement was assessed with the Cohen kappa.
Results |
We reviewed 21,514 isolates cultured from 6,974 veterans; 423 isolates met any CRE definition. Although agreement among definitions was high (kappa = 0.82-0.93), definitions including ertapenem resistance led to higher CRE prevalence (VA1 = 1.7% and CDC2 = 1.9% vs VA2 = 1.4% and CDC1 = 1.5%). Forty-four of 142 VA facilities had more than 1 CRE case defined by VA2; 10 facilities accounted for 60% of CRE cases. Almost all CRE was isolated from high-complexity, urban facilities, and the South had the highest proportion of CRE.
Conclusions |
Varying federal definitions give different CRE frequencies in a high-risk population. Definitions including ertapenem resistance resulted in higher CRE prevalence but may overemphasize noncarbapenemase isolates. Thus, both federal definitions now highlight the importance of carbapenemase testing.
Le texte complet de cet article est disponible en PDF.Key Words : Surveillance, Multidrug-resistant bacteria, Epidemiology
Plan
| This work was presented in part as a poster at the Society for Healthcare Epidemiology of America 2016 Spring Conference. |
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| Funding/support: Supported by funding from the Veterans Health Administration, Office of Research and Development, Rehabilitation Research and Development Service SPIRE Award (B-1583-P), Health Services Research and Development Service Presidential Early Career Award for Scientists and Engineers (USA 12-564), and Postdoctoral Fellowship Award (TPR 42-005). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government. |
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| Conflicts of interest: None to report. |
Vol 47 - N° 2
P. 175-179 - février 2019 Retour au numéro
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