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CRE cluster in Wisconsin helps to raise infection prevention awareness
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Public health officials were unable to determine what caused a cluster of carbapenem-resistant Enterobacteriaceae, or CRE, at two hospitals in Wisconsin last year, but used the case to raise awareness among infection prevention staff members about how the deadly bacteria can spread.
“The circumstances provided an opportunity for review of facility infection prevention practices and respiratory care processes critical to prevention of health care-associated pneumonia,” Lina I. Elbadawi, MD, of the CDC’s Epidemic Intelligence Service and the bureau of communicable diseases in the Wisconsin Division of Public Health (DPH), and colleagues reported in MMWR.
“After addressing these concerns, no evidence of further transmission of these closely related strains of [Klebsiella pneumoniae carbapenemase (KPC)]-CRE at these facilities was found.”
The report involved five closely related CRE isolates submitted to the Wisconsin State Laboratory of Hygiene between February and May 2015 as part of the department’s CRE surveillance program for clinical laboratories. The isolates came from four inpatients — all non-Hispanic whites, including two women — who received care at two hospitals in southeastern Wisconsin. Their median age was 65 years, and their median hospital stay was 83 days.
The state laboratory notified the DPH, which launched an investigation that included reviews of common care points between the patients, medical records and respiratory care protocols. Investigators made site visits and conducted interviews with infection prevention staff members, primary care providers and patients.
Rectal swabs were collected from patients (n = 83) hospitalized in the two respiratory units. Other than one specimen from a previously known patient with CRE whose infection was unrelated to the cluster, none of the 122 swabs taken during an approximately 1-month period were CRE-positive.
Elbadawi and colleagues observed no breaches in infection prevention protocols and policies for ventilator circuit care, but said infection control personnel “could not describe respiratory personnel hand hygiene practices after handling of the circuit tubing.”
In response, the DPH recommended that the hospitals conduct a compliance check of hand hygiene practices, and it also worked with infection control personnel on how to prevent infections related to ventilators. Since then, neither hospital has experienced further clusters of KPC-CRE.
Before the investigation, hospital personnel were unaware of the possibility of CRE transmission among patients, according to Elbadawi and colleagues.
“Although the precise mechanism of CRE transmission was not determined, DPH personnel used the detection of the KPC-CRE cluster to raise awareness among the hospitals’ infection prevention staff members regarding the possibility of intrafaculty CRE transmission events among their patients,” Elbadawi and colleagues wrote.
They also said the use of molecular subtyping methods such as pulsed-field gel electrophoresis and whole-genome sequencing was valuable to the investigation because it led to the identification of a cluster of CRE transmission, but cautioned that it could be too expensive to be routinely used by some states.
“Multidrug-resistant organisms, in particular CRE, have the capability of spreading undetected, with the possibility of devastating outbreaks in health care settings,” Elbadawi and colleagues concluded. “Routine hospital- and laboratory-based surveillance for the detection of CRE and the use of molecular techniques to characterize isolates can detect and reduce occurrence of multidrug-resistant infections through interventions designed to interrupt transmission. Timely access to technology and results can facilitate rapid implementation of effective interventions.” – by Gerard Gallagher
Disclosure: The researchers report no relevant financial disclosures.
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