BACKGROUND: Carbapenem-resistant Enterobacteriaceae(CRE) became laboratory reportable in West Virginia in August 2013. The following highlights characteristics of CRE infections reported between January 1, 2014 and December 31, 2014.
METHODS: CRE was defined as an Enterobacteriaceae that is nonsusceptible to one of the following carbapenems: doripenem, meropenem, or imipenem and resistant to all of the following third-generation cephalosporins that were tested: ceftriaxone, cefotaxime, and ceftazidime. Case counts were based on date of report. Each individual case was only counted one time, regardless of how many lab results are received for the individual. The exception to this is when a single individual is reported as being infected/colonized with more than one carbapenem-resistant organism. From January – December 2014, four individuals were diagnosed with two separate carbapenem-resistant organisms. Thus, the data were analyzed at the organism level and at the patient level.
RESULTS: One hundred and thirty-two (132) patients were reported and one hundred thirty-six (136) organisms were identified. The most common CREs reported were Klebsiella pneumoniae and Enterobacter cloacae. Excluding patients with missing data, 56/125 (45%) resided, or were being discharged to, a long term care facility (LTCF) while 72/126 (57%) were hospitalized at the time of specimen collection and 27/121 (22%) were neither hospitalized nor LTCF residents. Results were also analyzed regionally and two regions were identified as having the greatest number of cases; the Southern Region (n=48) and the Central Region (n=31). While cases from these two regions did not differ demographically, the potential healthcare exposures for cases did differ by region; 56% vs 24% (p=.009)were long term care residents in the Southern and Central Regions, respectively, while 41% vs. 77% (p=.002) were hospitalized at the time of specimen collection in the Southern and Central Regions, respectively. The most common organisms were also different by regions, with 54% vs 15% (p=.001) identified as Klebsiella pneumoniae in the Southern and Central Regions, respectively, and 30% vs. 55% (p=.06) identified as Enterobacter cloacae in the Southern and Central Regions, respectively.
CONCLUSIONS: This report provides a first glimpse into the number of cases of CRE in West Virginia and how case investigation efforts can be targeted to enhance prevention. Limitations include the fact that the mechanism of resistance for these organisms is unknown and the use of a passive surveillance system; some cases may not be reported, including West Virginia residents who seek medical care outside of the state.