tackling the nightmare bacteria carbapenem- resistant enterobacteriaceae (cre)—mandatory reporting...
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Tackling the Nightmare Bacteria Carbapenem-Resistant Enterobacteriaceae (CRE)—Mandatory
Reporting and Development of the Extensively Drug-Resistant Organism (XDRO) Registry in Illinois
Robynn Cheng Leidig, MPH2012 PHPS Fellow
Office for State, Tribal, Local and Territorial SupportCenters for Disease Control and Prevention
2015 PHAP/PHPS Summer SeminarJune 2, 2015
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support
BACKGROUND
What is CRE?CarbapenemResistantEnterobacteriaceae
Deadly infection Few treatment options (if any) Spreading quickly
http://www.cdc.gov/drugresistance/threat-report-2013/
CRE in Illinois
Facility type CRE colonization prevalence
Short stay acute care hospitals (adult ICUs) 3% Long term acute care hospitals (LTACHs) 30%
Few prevalence data existed for hospital non-ICU wards, nursing homes, and regions outside of Chicago
Chicago area facilities (REALM project), 2010-2011
Lin MY et al. CID, 2013
First recognized in Chicago area in December 2007
METHODSXDRO Registry Development
Illinois Department of Public Health (IDPH)
the Extensively Drug-Resistant Organism (XDRO) registry
the Chicago CDC Prevention Epicenter and Medical Research Analytics and Informatics Alliance (MRAIA)
Present…
Amendment to the Control of Communicable Diseases Code (77 Ill. Adm. Code 690) Rules
The XDRO registry addresses2 critical gaps
Gap XDRO registry
1. Need improved inter-facility communication
Allows for CRE information exchange
2. Lack of a surveillance system
Stores CRE surveillance data
CRE identified
XDRO registry
Patient admit (Unknown CRE status)
Isolation Precautions (Y/N)
Report
Query
ProvidersLaboratories
RESULTS
How to report: Extensively Drug-Resistant Organism (XDRO) Registry
Began: November 1, 2013
Required to report: Acute care hospitals Long-term acute care hospitalsLong-term care facilitiesLaboratories
CRE Reporting in Illinois
Apr
May Jun Jul
Aug
Sep
Oct
Nov De
c
Jan
Feb
Mar
ch
April
May
2014
0
20
40
60
80
100
120
Patie
nts (
#)Unique patients reported to XDRO registry
Mandatory reporting
2013
XDRO Registry: aggregate data (Nov 1, 2013 – May 13, 2015)
Number of unique patients since November 1st: 1,725
Number of unique facilities that:
have access to the registry 550
have submitted reports 151
have ever queried 127
Total number of queries that have been made: 2,522
Facilities
Local Health Depts.
Accessing CRE/ XDRO Data
CRE and XDRO education
- 30 stakeholder CRE Taskforce - 6 webinars: 605 people- 2 packets: 470 facilities - 2 websites- 1 Press release
Challenge Steps taken… Ensuring secure access to the XDRO registry
All users must register via IDPH web portal
Coordinating among various agencies and key players
Meetings, phone calls, internal webinars
Developing consistency in facility identifiers
Integrating with existing systems (I-NEDSS)
Meeting both clinical and public health needs
Input from public health and clinical stakeholders
Understanding surveillance criteria & reporting rules
Webinars, educational materials, consultations, registry improvements
Implications
Long-term impact Earlier detection of CRE+ patients Better infection control: 63% (N=203) took ≥1 infection control action as
a result of the webinars/ presentations Reduced spread of CRE in the region?
Source: CDC Vital Signs, March 2013
For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support
4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: http://www.cdc.gov/stltpublichealth
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
For more information visit: www.xdro.org
Robynn Cheng Leidig, [email protected]
312-814-1631
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support
EXTRA SLIDES FOR QUESTIONS
CRE surveillance definition(adapted from CDC CRE toolkit)
Reporting facilities shall report CRE based on laboratory test results:
1. Molecular test (e.g., PCR) specific for carbapenemaseOR
2. Phenotypic test (e.g., Modified Hodge) specific for carbapenemase production
OR3. Susceptibility tests (for E. coli and Klebsiella species only):
non-susceptible to ONE of the carbapenems (doripenem, meropenem, or imipenem) AND resistant to ALL third generation cephalosporins tested (ceftriaxone, cefotaxime, and ceftazidime). Ignore ertapenem.
http://www.cdc.gov/hai/organisms/cre/cre-toolkit
Resistance mechanisms reported to XDRO registry
n=36 n=22n=407
Not reported/ Unknown: 312 (40% of total patients)
KPC NDM Other0%
20%
40%
60%
80%
100%
88%
8%5%
System Maturation
*
Cluster Detection
• SaTScan: Spacial scanning software
• Arcview GIS: Provides graphical display