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Improving containment and prevention strategies using a patient transfer network representative of patients with multidrug-resistant organisms

Published online by Cambridge University Press:  23 June 2025

Rany Octaria Open the ORCID record for Rany Octaria [Opens in a new window] ,
Stephen Deppen ,
Allison Chan ,
James C. Slaughter ,
Pamela Talley Open the ORCID record for Pamela Talley [Opens in a new window] ,
Rachel B. Slayton Open the ORCID record for Rachel B. Slayton [Opens in a new window] ,
Peter F. Rebeiro Open the ORCID record for Peter F. Rebeiro [Opens in a new window]  and
Marion A. Kainer Open the ORCID record for Marion A. Kainer [Opens in a new window]
Rany Octaria*
Affiliation:
Vanderbilt Epidemiology Ph.D. Program, Vanderbilt University Graduate School, Nashville, TN, USA Healthcare-Associated Infections and Antimicrobial Resistance Program, Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, TN, USA
Stephen Deppen
Affiliation:
Department of Thoracic Surgery and Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
Allison Chan
Affiliation:
Healthcare-Associated Infections and Antimicrobial Resistance Program, Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, TN, USA
James C. Slaughter
Affiliation:
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
Pamela Talley
Affiliation:
HIV/STI/Viral Hepatitis Program, Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, TN, USA
Rachel B. Slayton
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
Peter F. Rebeiro
Affiliation:
Department of Medicine, Vanderbilt University, Nashville, TN, USA
Marion A. Kainer
Affiliation:
Healthcare-Associated Infections and Antimicrobial Resistance Program, Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, TN, USA Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
*
Corresponding author: Rany Octaria; Email: ranyoctaria@gmail.com
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Abstract

Objectives:

Interfacility patient transfers contribute to the regional spread of multidrug-resistant organisms (MDROs). We evaluated whether transfer patterns of inpatients with similar characteristics to carbapenem-resistant Enterobacterales (CRE) case-patients (CRE surrogates) better reflect hospital-level CRE burden than traditionally used populations.

Design:

We determined the risk factors for subsequent hospital admission using demographic and clinical information from Tennessee Department of Health tracked CRE case-patients from July 2015 to September 2019. Risk factors were used to identify CRE surrogates among inpatients in the 2018 Tennessee Hospital Discharge Data System (HDDS). Transfer networks of CRE surrogates, Medicare/TennCare beneficiaries, and all-inpatients with ≤365 days of intervening community stays were compared with the transfer networks of CRE case-patients in 2019. The associations between hospital-level CRE prevalence and hospitals’ incoming transfer volumes from each network were assessed using negative binomial regression models.

Results:

Eight risk factors for subsequent hospital admission were identified from 2,518 CRE case-patients, which were used to match CRE case-patients with HDDS inpatients, resulting in 10,069 surrogate patients. CRE surrogate network showed more structural similarities with the CRE case-patient network than with the all-inpatient and Medicare/TennCare networks. A 33% increase in hospitals’ CRE prevalence in 2019 was associated with each doubling of incoming transfer of CRE surrogates in 2018 (adjusted Risk Ratio [aRR] 1.33, 95%CI: 1.1, 1.59), higher than all-inpatient (aRR 1.27, 95% CI: 1.08, 1.51) and Medicare/TennCare networks (aRR 1.21, 95% CI: 1.02, 1.44).

Conclusions:

Surrogate transfer patterns were associated with hospital-level CRE prevalence, highlighting their value in MDRO containment and prevention.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , First View , pp. 1 - 9
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

a

Current affiliation: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.

b

Current affiliation: Infectious Diseases, Western Health, Footscray, Victoria, Australia.

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