CDC increases infection control measures for carbapenem-resistant bug

January 12th, 2015

Patients who tested positive for carbapenem-resistant Enterobacteriaceae (CRE) took an average of 387 days following hospital discharge clear of the organism, according to a new study published in the current issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).(1)

The study was conducted in the Shaare Zedek Medical Center, a 700-bed university-affiliated general hospital in Jerusalem, Israel. The research team analyzed follow-up cultures from 97 CRE-positive patients who had been discharged from the medical center between January 2009 and December 2010.

The average time until cultures became negative was 387 days. At three months, 78 percent of patients remained culture positive; at six months, 65 percent remained positive; at nine months, 51 percent, and at one year 39 percent of patients remained positive, meaning they could potentially become re-infected or transmit the germ to others.

Risk factors for extended carriage included the number of hospitalization days, whether and how often the patient was re-hospitalized, and whether the patient had an active infection as opposed to colonization without signs of active disease.

This is one of the first studies to determine length of CRE duration after hospital discharge and provides vital insight into treating formerly CRE-positive patients upon readmission as to limit the spread of this virulent and often deadly pathogen.

The authors state, “Patients with multiple hospitalizations or those who were diagnosed with clinical CRE disease should be assumed to have a more extended duration of CRE coverage and should therefore be admitted under conditions of isolation and cohorting until proven to be CRE-negative. These measures will reduce the hospitalization of CRE-positive patients among the general patient population, potentially preventing the spread of CRE.”

In that regard the Centers for Disease Control and Prevention recently issued a health alert advising the need for additional measures with CRE. The CDC advises:

• Ensure that the patient is on Contact Precautions.
• Reinforce and evaluate adherence to hand hygiene and Contact Precautions for healthcare personnel who come into contact with the patient (e.g., enter the patient’s room).
• Since clinical cultures will identify only a minority of patients with CRE, screen epidemiologically linked patient contacts for CRE colonization with stool, rectal, or perirectal cultures. At a minimum, this should include persons with whom the CRE patient shared a room but could also include patients who were treated by the same healthcare personnel. A laboratory-based screening protocol is available.
• Should the patient be transferred to another healthcare facility, ensure that the presence of CRE colonization or infection is communicated to the accepting facility. An example transfer form is available here.
• Dedicate rooms and staff to CRE patients when possible. It is preferred that staff caring for CRE patients do not also care for non-CRE patients.
• Remove temporary medical devices as soon as they are no longer needed.

Reference

1. Zimmerman FS, Assous MV, Abram TB, et al. Duration of carriage of carbapenem-resistant Enterobacteriaceae following hospital discharge. American Journal of Infection Control 2013; 41[3].