CRE more prevalent than indicated by previous CDC reports

Carbapenem-resistant Enterobacteriaceae infections are more widespread in the United States than reported by the CDC in 2013, according to research presented at the Society for Healthcare Epidemiology of America’s spring conference.

“In our multicenter retrospective cohort study in U.S. hospitals, we found that the annual burden of [carbapenem-resistant Enterobacteriaceae (CRE)] may be at least 3 times greater than previously estimated,” researcher Marya Zilberberg, MD, MPH, president and CEO of the EviMed Research Group, told Infectious Diseases in Children. Zilberberg and colleagues suggest that the total burden caused by this type of infection as well as its prodigious growth “signal the need for urgent measures to contain this public health hazard.”

To assess the national burden and possible sources of CRE in the U.S., the researchers examined the Cerner Health Facts for all inpatient hospitalizations with laboratory–confirmed CRE infections from 2009 to 2015. The researchers defined incident CRE infections as “the first CRE isolate from a patient within a 30-day period.”

Zilberberg and colleagues calculated hospital weights by dividing the number of hospitals that are listed in the IMS Healthcare Organizational Service database by those in Cerner Health Facts data. Strata was defined by various combinations of census region, bed size, urban or rural setting, and teaching.

Over the study period, the researchers identified 20,137 incident CRE infections. In the U.S. alone, researchers found 231,701 cases, and observed a dramatic increase in projected counts: 8,191 cases in 2009 vs. 65,408 in 2015. The highest occurrence of CRE infections were found in the Middle Atlantic census division (31%), followed by West South Central (24%) and East South Central (18%).

A large percent of urinary (43.5%), respiratory (21.1%) or blood infections were the source of CRE. Over the duration of the study, the researchers observed that the use of urinary cultures increased from 34.1% in 2009 to 45.0% in 2015, while conversely, the use of respiratory cultures decreased from 27.5% to 17.8% and blood cultures from 11.6% to 7.8%.

“[This research] indicates that current surveillance efforts may be limited,” Zilberberg told Infectious Diseases in Children. “Our data may provide a rationale to expand them.” —by Katherine Bortz

Reference:

Zilberberg M, et al. Abstract 9195. Presented at: The Society for Healthcare Epidemiology of America spring conference; March 29-31, 2017; St. Louis, MO.

Disclosure: The researchers report no relevant financial disclosures.