BACKGROUND: Multidrug-resistant organisms like carbapenem-resistant Enterobacteriaceae (CRE) are difficult to treat, have been associated with high mortality rates, and have the potential to spread extensively in healthcare facilities and in the community. The approach to controlling transmission of CRE in healthcare facilities includes understanding the prevalence in the region. Although 21 states and counting have already made CRE reportable, information about prevalence is limited since CRE infections are not reportable in Arkansas or nationally.
METHODS: A survey was developed in SurveyMonkey© and sent to Infection Preventionists at all acute care, long-term acute care, and critical access hospitals in the state of Arkansas. The survey asked facilities how many isolates of E. coli, Klebsiella spp., and Enterobacter spp. were identified and how many were classified as CRE in 2014, as defined by the current CSTE case definition. However, no specific laboratory criteria such as minimum inhibitory concentration (MIC) profiles were defined. Information on lab capabilities and processes of alerting staff of a CRE infection were also collected.
RESULTS: The survey response rate was 53% as 42/80 facilities completed the survey by fax, email, or SurveyMonkey©. Of the 42 facilities, 21 (50%) reported having at least one CRE-infected or -colonized patient present in their facility in 2014. These facilities were distributed across Arkansas, with the majority in the Northwest Region. Of the reported isolates, 72/18,583 (<1%) E. coli, 46/5,726 (<1%) Klebsiella spp., and 90/1,589 (5.7%) Enterobacter spp. were identified as carbapenem-resistant. Most facilities (79%) indicated having an on-site microbiology laboratory at their facility, and 88% report that they have or have access to a laboratory that has the capability to identify the production of a carbapenemase. Of the 208 reported carbapenem-resistant isolates, only 41 (20%) were confirmed as carbapenemase-producing. Among the 42 facilities, 36 (86%) stated that the microbiology laboratory that performs cultures for their facility has an established system for alerting infection prevention staff in a timely manner whenever a CRE isolate is identified. Only three facilities (7%) reported performing any form of CRE screening.
CONCLUSIONS: Although CRE were particularly rare in 2014 in those facilities that completed the survey (<1%), 50% of the respondents reported having at least one CRE in their facility. The results of this survey will allow the Arkansas Department of Health (ADH) to develop regional interventions and education to tackle CRE. To address limited availability of CRE mechanism testing, ADH is implementing polymerase chain reaction (PCR) capabilities.