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BACKGROUND: Regional approaches to control carbapenem-resistant Enterobacteriaceae (CRE) and other multi-drug resistant organisms (MDRO) are essential. Health departments play a key role and may be more effective by combining strengths and capabilities. Department capacity in molecular microbiology services and hospital epidemiology expertise varies from state to state. Washington State (WA) recently linked its public health lab with an NIH-funded microbiology research lab, and has been collaborating with Oregon (OR) and California (CA) to promote a pacific coast regional surveillance network for CRE.
METHODS: Through quarterly phone calls and yearly in-person meetings, WA, OR and CA identify priorities for collaboration, and share surveillance data and strategies for preventing transmission and promoting antimicrobial stewardship. We share draft documents to promote consensus, consulting US Centers for Disease Control and Prevention (CDC) on key issues.
RESULTS: Our health departments differ in lab capacity, surveillance definitions and case-finding approaches. To improve understanding of regional patterns, the research lab sought CRE samples from a wider population area than WA alone. Ethics review approval is needed to cover sharing of patient information & isolates. WA used its notifiable conditions law to add voluntary CRE reporting, discovered >75 cases, including 6 CP-CRE, and through advanced capabilities of its research lab partner learned more about the molecular epidemiology than otherwise would be possible. OR instituted a statewide network to rapidly detect and provide case by case assistance with identified CRE. CA has a statewide CRE prevalence survey underway in acute care hospitals to determine regional prevalence & assist hospitals in implementing CDC’s CRE Toolkit. Los Angeles County implemented county-wide mandatory lab reporting of CR Klebsiella pneumoniae using Clinical Laboratory Standards Institute criteria; from 2010-2012 2,163 cases were reported with disproportionally large number from long term acute care hospitals. All three states are working to identify methods to regionally standardize case detection, ensure rapid communication of information regarding movement of CRE between facilities and states, improve efficiency of isolate processing and promote antimicrobial stewardship.
CONCLUSIONS: Our attempt to build a pacific coast collaboration spanning WA, OR & CA is a work in progress. We believe a regional approach will be more comprehensive and successful in combating MDROs than would be possible by state health departments acting individually.