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Provider Role in Transmission of Carbapenem-Resistant Enterobacteriaceae

Published online by Cambridge University Press:  24 October 2017

Marika E. Grabowski ,
Hyojung Kang ,
Kristen M. Wells ,
Costi D. Sifri ,
Amy J. Mathers  and
Jennifer M. Lobo
Marika E. Grabowski
Affiliation:
Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
Hyojung Kang
Affiliation:
Department of Systems and Information Engineering, University of Virginia, Charlottesville, Virginia
Kristen M. Wells
Affiliation:
Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
Costi D. Sifri
Affiliation:
Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia
Amy J. Mathers
Affiliation:
Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia
Jennifer M. Lobo*
Affiliation:
Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
*
Address correspondence to Jennifer M. Lobo, PhD, 1300 Jefferson Park Avenue, PO Box 800717, Charlottesville, VA 22908 (jem4yb@virginia.edu).
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Abstract

OBJECTIVE

We sought to evaluate the role healthcare providers play in carbapenem-resistant Enterobacteriaceae (CRE) acquisition among hospitalized patients.

DESIGN

A 1:4 case-control study with incidence density sampling.

SETTING

Academic healthcare center with regular CRE perirectal screening in high-risk units.

PATIENTS

We included case patients with ≥1 negative CRE test followed by positive culture with a length of stay (LOS) >9 days. For controls, we included patients with ≥2 negative CRE tests and assignment to the same unit set as case patients with a LOS >9 days.

METHODS

Controls were time-matched to each case patient. Case exposure was evaluated between days 2 and 9 before positive culture and control evaluation was based on maximizing overlap with the case window. Exposure sources were all CRE-colonized or -infected patients. Nonphysician providers were compared between study patients and sources during their evaluation windows. Dichotomous and continuous exposures were developed from the number of source-shared providers and were used in univariate and multivariate regression.

RESULTS

In total, 121 cases and 484 controls were included. Multivariate analysis showed odds of dichotomous exposure (≥1 source-shared provider) of 2.27 (95% confidence interval [CI], 1.25–4.15; P=.006) for case patients compared to controls. Multivariate continuous exposure showed odds of 1.02 (95% CI, 1.01–1.03; P=.009) for case patients compared to controls.

CONCLUSIONS

Patients who acquire CRE during hospitalization are more likely to receive care from a provider caring for a patient with CRE than those patients who do not acquire CRE. These data support the importance of hand hygiene and cohorting measures for CRE patients to reduce transmission risk.

Infect Control Hosp Epidemiol 2017;38:1329–1334

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 11 , November 2017 , pp. 1329 - 1334
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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