How frequently are hospitalized patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) already on contact precautions for other indications?

Abstract

Using samples collected for VRE surveillance, we evaluated unit admission prevalence of carbapenem-resistant Enterobacteriaceae (CRE) perirectal colonization and whether CRE carriers (unknown to staff) were on contact precautions for other indications. CRE colonization at unit admission was infrequent (3.9%). Most CRE carriers were not on contact precautions, representing a reservoir for healthcare-associated CRE transmission.

Figure.

Indications for Contact Precautions at Unit Admission in Patients Who Test Positive for Non-Carbapenemasing-Producing (non-CP-CRE) and Carbapenemase-Producing (CP-CRE) Colonization^a Indications for contact precautions among non-CP-CRE (n=159) and CP-CRE (n=13) colonized patients who were on contact precautions at unit admission. There were 126 CRE carriers (overall) during the study period (100 non-CP-CRE and 26 CP-CRE), 57% of whom (72, 59 non-CP-CRE and 13 CP-CRE) were on contact precautions at unit admission. Abbreviations: MRSA – methicillin-resistant Staphylococcus aureus; VRE – Vancomycin-resistant Enteroccocus; MDRGN – multidrug-resistant Gram-negative bacteria (defined as Gram-negative rods other than non-fermenters resistant to 3 of 5 antibiotic classes, non-fermenters resistant to 4 of 5 antibiotic classes, trimethoprim and sulfamethoxazole-resistant Stenotrophomonas spp., extended-spectrum β-lactamase (ESBL)-producing bacteria, and/or specified Enterobacteriaceae resistant to ceftriaxone); CRE – Carbapenem-resistant Enterobacteriaceae (defined as resistance to any carbapenem); C. diff – Clostridioides difficile; Resp. Virus – Respiratory viruses; and Other – Other indications, including enteric pathogens, “CRE Rule-Out” for recent internationally hospitalized patients, and unspecified reasons. ^a Percentages exceed 100%, due to >1 possible indication per patient.