Detecting 20 Percent of Bacterial Carriers Could Significantly Reduce Infection Spread

Identifying at least 20 percent of hospitalized patients who carry carbapenem-resitant Enterobacteriaceae(CRE)—drug-resistant bacteria that can lead to a dangerous healthcare-associated infection—could help prevent spread of the organism, according to an AHRQ-funded study published in the Journal of Infectious Diseases. Researchers developed a computer model to understand the impact of detecting an increasing number of carriers of CRE in adult inpatient healthcare facilities in Orange County, California. They determined that detecting one out of every five carriers of CRE and using contact precautions during care of the identified carriers would be sufficient to significantly reduce the spread of the bacteria in a large population. Researchers also noted that eliminating all CRE carriage would be ideal but is not feasible. Access the abstract.

2019 May 31. pii: jiz288. doi: 10.1093/infdis/jiz288. [Epub ahead of print]

Knowing More of the Iceberg: How Detecting a Greater Proportion of Carbapenem-Resistant Enterobacteriaceae (CRE) Carriers Impacts Transmission.

Bartsch SM1, Wong KF2, Stokes-Cawley OJ1, McKinnell JA3,4, Cao C5, Gussin GM5, Mueller LE1, Kim DS5, Miller LG4, Huang SS5, Lee BY1.

Author information

1: Public Health Computational and Operations Research (PHICOR) and Global Obesity Prevention Center (GOPC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
2: Center for Simulation and Modeling, University of Pittsburgh, Pittsburgh, PA.
3: Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA.
4: Torrance Memorial Medical Center, Torrance, CA.
5: Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine Health School of Medicine, Irvine, CA.

Abstract

BACKGROUND:

Clinical testing detects a fraction of carbapenem-resistant Enterobacteriaceae (CRE) carriers. Detecting a greater proportion could lead to increased use of infection prevention and control measures but requires resources. Therefore, it is important to understand the impact of detecting increasing proportions of CRE carriers.

METHODS:

We used our Regional Healthcare Ecosystem Analyst-generated agent-based model of adult inpatient healthcare facilities in Orange County, California to explore the impact of detecting greater proportions of carriers on CRE spread.

RESULTS:

Detecting and placing 1 in 9 carriers on contact precautions increased prevalence from 0% to 8.0% countywide over 10 years. Increasing the proportion of detected carriers yielded linear reductions in transmission up to detecting 1 in 5 carriers; after this, reductions were greater than linear. Transmission reductions did not occur for 1, 4, or 5 years, varying by facility type. With 70% contact precaution effectiveness, the detection level yielding non-linear reductions remained unchanged; with >80% effectiveness, detecting only 1 in 5 garnered large reductions in CRE carriers. Trends held when CRE was already present in the region.