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BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) are difficult-to-treat organisms that are non-susceptible to nearly all antibiotics. In response to this threat, the Illinois Department of Public Health and Chicago CDC Prevention Epicenter launched the XDRO registry 11/1/2013. Acute care hospitals, long-term care facilities, and laboratories must report CRE to this web-based registry. In the first year, we assessed registry functionality and CRE epidemiology.
METHODS: Reports submitted through 10/31/2014 were de-duplicated by patient name and birth date. Specimen source, organism, and laboratory testing methods were evaluated against the surveillance definition to assess data quality. Early data entry errors and user feedback helped identify misconceptions about the CRE definition and reporting requirements. In response, we modified the electronic reporting form and provided training. Healthcare facilities can manually query whether a patient of unknown CRE status was previously reported to the registry as CRE-positive. For more efficient inter-facility communication, an automated alert process has been developed using the Public Health Node’s existing structure.
RESULTS: During the first year, 136 facilities submitted 1,521 CRE reports. Among 1,073 unique patients, 51% were female. Mean age was 64 years. Top specimen sources were urine cultures (44%) and rectal screenings (22%). The most commonly reported organisms were Klebsiella spp. (85%), Escherichia coli (7%) and Enterobacter spp. (5%). Of the 30% of cases with molecular testing reported, 91% tested positive for Klebsiella pneumoniae carbapenemase and 4% for New Delhi metallo-β-lactamase. 24% of cases were reported based on susceptibility testing results alone. Structural changes to the report form included more required fields, logic checks, and pop-up windows to guide the user. Six webinars on CRE control and reporting requirements reached 605 people. This led to fewer non-CREs and more complete information on testing methods being reported. The registry was queried 1,402 times by 110 facilities. Four hospitals are piloting automated alert functionality, in which encrypted patient admission lists are automatically sent to the registry. If a match is found in the registry, an email notifies the facility’s infection preventionist to review the alert.
CONCLUSIONS: In its first year, the XDRO registry has provided important information on CRE epidemiology in Illinois. Future laboratory validation can help ensure the accuracy of submitted reports, as nearly one-quarter of CRE isolates are reported based on susceptibility testing alone. Few facilities are consistently querying the registry, indicating a need for expanded automated alerting to support more efficient communication and help prevent the spread of CRE.