How Introducing a Registry With Automated Alerts for Carbapenem-resistant Enterobacteriaceae (CRE) May Help Control CRE Spread in a Region

Abstract

Background: Regions are considering the use of electronic registries to track patients who carry antibiotic-resistant bacteria, including carbapenem-resistant Enterobacteriaceae (CRE). Implementing such a registry can be challenging and requires time, effort, and resources; therefore, there is a need to better understand the potential impact.

Methods: We developed an agent-based model of all inpatient healthcare facilities (90 acute care hospitals, 9 long-term acute care hospitals, 351 skilled nursing facilities, and 12 ventilator-capable skilled nursing facilities) in the Chicago metropolitan area, surrounding communities, and patient flow using our Regional Healthcare Ecosystem Analyst software platform. Scenarios explored the impact of a registry that tracked patients carrying CRE to help guide infection prevention and control.

Results: When all Illinois facilities participated (n = 402), the registry reduced the number of new carriers by 11.7% and CRE prevalence by 7.6% over a 3-year period. When 75% of the largest Illinois facilities participated (n = 304), registry use resulted in a 11.6% relative reduction in new carriers (16.9% and 1.2% in participating and nonparticipating facilities, respectively) and 5.0% relative reduction in prevalence. When 50% participated (n = 201), there were 10.7% and 5.6% relative reductions in incident carriers and prevalence, respectively. When 25% participated (n = 101), there was a 9.1% relative reduction in incident carriers (20.4% and 1.6% in participating and nonparticipating facilities, respectively) and 2.8% relative reduction in prevalence.

Conclusions: Implementing an extensively drug-resistant organism registry reduced CRE spread, even when only 25% of the largest Illinois facilities participated due to patient sharing. Nonparticipating facilities garnered benefits, with reductions in new carriers.

Keywords: CRE; electronic registry; modeling; transmission.

Figure 1.

Carbapenem-resistant Enterobacteriaceae (CRE) prevalence in healthcare facilities regionwide over time when different proportions of the largest facilities in Illinois (IL) participate and use an extensively drug-resistant organism (XDRO) registry (assumes 60% of all CRE carriers are in the XDRO registry).

Figure 2.

Impact of the proportion of Illinois healthcare facilities participating and utilizing an extensively drug-resistant organism (XDRO) registry (60% of all carriers in the registry) on the cumulative number of new carbapenem-resistant Enterobacteriaceae (CRE) carriers regionwide (transmission events) over 3 simulated years. Box represents the interquartile range (25th and 75th percentile), the central line in each box is the median, whiskers are the minimum and maximum. Only facilities in the Chicago region within the state of Illinois were eligible to participate in the XDRO registry (100%: 402 facilities and 64 022 total beds; 75%: 304 facilities and 57 022 beds; 50%: 201 facilities and 44 382 beds; 25%: 101 facilities and 27 232 beds).

Figure 3.

Relative reduction (%) in the total number of incident carbapenem-resistant Enterobacteriaceae (CRE) carriers over a 3-year period when using an extensively drug-resistant organism (XDRO) registry (60% of all CRE carriers are in the registry) compared to no XDRO registry when varying Illinois healthcare facility participation. “Participating facilities” shows the direct impact, or the reduction occurring in those facilities that participate and use the registry compared to when they did not. “Nonparticipating facilities” shows the indirect impact, or the reduction occurring in those facilities that do not participate in the registry. Only facilities in the Chicago region within the state of Illinois were eligible to participate in the XDRO registry (100%: 402 facilities and 64 022 total beds; 75%: 304 facilities and 57 022 beds; 50%: 201 facilities and 44 382 beds; 25%: 101 facilities and 27 232 beds). Nonparticipating facilities in the 100% of Illinois facilities scenario are those healthcare facilities in Indiana and Wisconsin that were not eligible to participate in the registry.