Tackling the Nightmare Bacteria Carbapenem- Resistant Enterobacteriaceae (CRE)—Mandatory Reporting and Development of the Extensively Drug- Resistant Organism.

Tackling the Nightmare Bacteria Carbapenem-Resistant Enterobacteriaceae (CRE)—Mandatory

Reporting and Development of the Extensively Drug-Resistant Organism (XDRO) Registry in Illinois

Robynn Cheng Leidig, MPH2012 PHPS Fellow

Office for State, Tribal, Local and Territorial SupportCenters for Disease Control and Prevention

2015 PHAP/PHPS Summer SeminarJune 2, 2015

Centers for Disease Control and Prevention

Office for State, Tribal, Local and Territorial Support

BACKGROUND

What is CRE?CarbapenemResistantEnterobacteriaceae

Deadly infection Few treatment options (if any) Spreading quickly

http://www.cdc.gov/drugresistance/threat-report-2013/

CRE in Illinois

Facility type CRE colonization prevalence

Short stay acute care hospitals (adult ICUs) 3% Long term acute care hospitals (LTACHs) 30%

Few prevalence data existed for hospital non-ICU wards, nursing homes, and regions outside of Chicago

Chicago area facilities (REALM project), 2010-2011

Lin MY et al. CID, 2013

First recognized in Chicago area in December 2007

METHODSXDRO Registry Development

Illinois Department of Public Health (IDPH)

the Extensively Drug-Resistant Organism (XDRO) registry

the Chicago CDC Prevention Epicenter and Medical Research Analytics and Informatics Alliance (MRAIA)

Present…

Amendment to the Control of Communicable Diseases Code (77 Ill. Adm. Code 690) Rules

The XDRO registry addresses2 critical gaps

Gap XDRO registry

1. Need improved inter-facility communication

Allows for CRE information exchange

2. Lack of a surveillance system

Stores CRE surveillance data

CRE identified

XDRO registry

Patient admit (Unknown CRE status)

Isolation Precautions (Y/N)

Report

Query

ProvidersLaboratories

RESULTS

How to report: Extensively Drug-Resistant Organism (XDRO) Registry

Began: November 1, 2013

Required to report: Acute care hospitals Long-term acute care hospitalsLong-term care facilitiesLaboratories

CRE Reporting in Illinois

Apr

May Jun Jul

Aug

Sep

Oct

Nov De

c

Jan

Feb

Mar

ch

April

May

2014

0

20

40

60

80

100

120

Patie

nts (

#)Unique patients reported to XDRO registry

Mandatory reporting

2013

XDRO Registry: aggregate data (Nov 1, 2013 – May 13, 2015)

Number of unique patients since November 1st: 1,725

Number of unique facilities that:

have access to the registry 550

have submitted reports 151

have ever queried 127

Total number of queries that have been made: 2,522

Facilities

Local Health Depts.

Accessing CRE/ XDRO Data

CRE and XDRO education

- 30 stakeholder CRE Taskforce - 6 webinars: 605 people- 2 packets: 470 facilities - 2 websites- 1 Press release

Challenge Steps taken… Ensuring secure access to the XDRO registry

All users must register via IDPH web portal

Coordinating among various agencies and key players

Meetings, phone calls, internal webinars

Developing consistency in facility identifiers

Integrating with existing systems (I-NEDSS)

Meeting both clinical and public health needs

Input from public health and clinical stakeholders

Understanding surveillance criteria & reporting rules

Webinars, educational materials, consultations, registry improvements

Implications

Long-term impact Earlier detection of CRE+ patients Better infection control: 63% (N=203) took ≥1 infection control action as

a result of the webinars/ presentations Reduced spread of CRE in the region?

Source: CDC Vital Signs, March 2013

For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support

4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: http://www.cdc.gov/stltpublichealth

The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

For more information visit: www.xdro.org

Robynn Cheng Leidig, [email protected]

312-814-1631

Centers for Disease Control and Prevention

Office for State, Tribal, Local and Territorial Support

EXTRA SLIDES FOR QUESTIONS

CRE surveillance definition(adapted from CDC CRE toolkit)

Reporting facilities shall report CRE based on laboratory test results:

1. Molecular test (e.g., PCR) specific for carbapenemaseOR

2. Phenotypic test (e.g., Modified Hodge) specific for carbapenemase production

OR3. Susceptibility tests (for E. coli and Klebsiella species only):

non-susceptible to ONE of the carbapenems (doripenem, meropenem, or imipenem) AND resistant to ALL third generation cephalosporins tested (ceftriaxone, cefotaxime, and ceftazidime). Ignore ertapenem.

http://www.cdc.gov/hai/organisms/cre/cre-toolkit

Resistance mechanisms reported to XDRO registry

n=36 n=22n=407

Not reported/ Unknown: 312 (40% of total patients)

KPC NDM Other0%

20%

40%

60%

80%

100%

88%

8%5%

System Maturation

*

Cluster Detection

• SaTScan: Spacial scanning software

• Arcview GIS: Provides graphical display