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The Potential Trajectory of Carbapenem-Resistant Enterobacteriaceae, an Emerging Threat to Health-Care Facilities, and the Impact of the Centers for Disease Control and Prevention Toolkit

Carbapenem-resistant Enterobacteriaceae (CRE), a group of pathogens resistant to most antibiotics and associated with high mortality, are a rising emerging public health threat. Current approaches to infection control and prevention have not been adequate to prevent spread. An important but unproven...

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Autores principales: Lee, Bruce Y., Bartsch, Sarah M., Wong, Kim F., McKinnell, James A., Slayton, Rachel B., Miller, Loren G., Cao, Chenghua, Kim, Diane S., Kallen, Alexander J., Jernigan, John A., Huang, Susan S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772438/
https://www.ncbi.nlm.nih.gov/pubmed/26861238
http://dx.doi.org/10.1093/aje/kwv299
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author Lee, Bruce Y.
Bartsch, Sarah M.
Wong, Kim F.
McKinnell, James A.
Slayton, Rachel B.
Miller, Loren G.
Cao, Chenghua
Kim, Diane S.
Kallen, Alexander J.
Jernigan, John A.
Huang, Susan S.
author_facet Lee, Bruce Y.
Bartsch, Sarah M.
Wong, Kim F.
McKinnell, James A.
Slayton, Rachel B.
Miller, Loren G.
Cao, Chenghua
Kim, Diane S.
Kallen, Alexander J.
Jernigan, John A.
Huang, Susan S.
author_sort Lee, Bruce Y.
collection PubMed
description Carbapenem-resistant Enterobacteriaceae (CRE), a group of pathogens resistant to most antibiotics and associated with high mortality, are a rising emerging public health threat. Current approaches to infection control and prevention have not been adequate to prevent spread. An important but unproven approach is to have hospitals in a region coordinate surveillance and infection control measures. Using our Regional Healthcare Ecosystem Analyst (RHEA) simulation model and detailed Orange County, California, patient-level data on adult inpatient hospital and nursing home admissions (2011–2012), we simulated the spread of CRE throughout Orange County health-care facilities under 3 scenarios: no specific control measures, facility-level infection control efforts (uncoordinated control measures), and a coordinated regional effort. Aggressive uncoordinated and coordinated approaches were highly similar, averting 2,976 and 2,789 CRE transmission events, respectively (72.2% and 77.0% of transmission events), by year 5. With moderate control measures, coordinated regional control resulted in 21.3% more averted cases (n = 408) than did uncoordinated control at year 5. Our model suggests that without increased infection control approaches, CRE would become endemic in nearly all Orange County health-care facilities within 10 years. While implementing the interventions in the Centers for Disease Control and Prevention's CRE toolkit would not completely stop the spread of CRE, it would cut its spread substantially, by half.
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spelling pubmed-47724382016-03-01 The Potential Trajectory of Carbapenem-Resistant Enterobacteriaceae, an Emerging Threat to Health-Care Facilities, and the Impact of the Centers for Disease Control and Prevention Toolkit Lee, Bruce Y. Bartsch, Sarah M. Wong, Kim F. McKinnell, James A. Slayton, Rachel B. Miller, Loren G. Cao, Chenghua Kim, Diane S. Kallen, Alexander J. Jernigan, John A. Huang, Susan S. Am J Epidemiol Practice of Epidemiology Carbapenem-resistant Enterobacteriaceae (CRE), a group of pathogens resistant to most antibiotics and associated with high mortality, are a rising emerging public health threat. Current approaches to infection control and prevention have not been adequate to prevent spread. An important but unproven approach is to have hospitals in a region coordinate surveillance and infection control measures. Using our Regional Healthcare Ecosystem Analyst (RHEA) simulation model and detailed Orange County, California, patient-level data on adult inpatient hospital and nursing home admissions (2011–2012), we simulated the spread of CRE throughout Orange County health-care facilities under 3 scenarios: no specific control measures, facility-level infection control efforts (uncoordinated control measures), and a coordinated regional effort. Aggressive uncoordinated and coordinated approaches were highly similar, averting 2,976 and 2,789 CRE transmission events, respectively (72.2% and 77.0% of transmission events), by year 5. With moderate control measures, coordinated regional control resulted in 21.3% more averted cases (n = 408) than did uncoordinated control at year 5. Our model suggests that without increased infection control approaches, CRE would become endemic in nearly all Orange County health-care facilities within 10 years. While implementing the interventions in the Centers for Disease Control and Prevention's CRE toolkit would not completely stop the spread of CRE, it would cut its spread substantially, by half. Oxford University Press 2016-03-01 2016-02-08 /pmc/articles/PMC4772438/ /pubmed/26861238 http://dx.doi.org/10.1093/aje/kwv299 Text en © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Practice of Epidemiology
Lee, Bruce Y.
Bartsch, Sarah M.
Wong, Kim F.
McKinnell, James A.
Slayton, Rachel B.
Miller, Loren G.
Cao, Chenghua
Kim, Diane S.
Kallen, Alexander J.
Jernigan, John A.
Huang, Susan S.
The Potential Trajectory of Carbapenem-Resistant Enterobacteriaceae, an Emerging Threat to Health-Care Facilities, and the Impact of the Centers for Disease Control and Prevention Toolkit
title The Potential Trajectory of Carbapenem-Resistant Enterobacteriaceae, an Emerging Threat to Health-Care Facilities, and the Impact of the Centers for Disease Control and Prevention Toolkit
title_full The Potential Trajectory of Carbapenem-Resistant Enterobacteriaceae, an Emerging Threat to Health-Care Facilities, and the Impact of the Centers for Disease Control and Prevention Toolkit
title_fullStr The Potential Trajectory of Carbapenem-Resistant Enterobacteriaceae, an Emerging Threat to Health-Care Facilities, and the Impact of the Centers for Disease Control and Prevention Toolkit
title_full_unstemmed The Potential Trajectory of Carbapenem-Resistant Enterobacteriaceae, an Emerging Threat to Health-Care Facilities, and the Impact of the Centers for Disease Control and Prevention Toolkit
title_short The Potential Trajectory of Carbapenem-Resistant Enterobacteriaceae, an Emerging Threat to Health-Care Facilities, and the Impact of the Centers for Disease Control and Prevention Toolkit
title_sort potential trajectory of carbapenem-resistant enterobacteriaceae, an emerging threat to health-care facilities, and the impact of the centers for disease control and prevention toolkit
topic Practice of Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772438/
https://www.ncbi.nlm.nih.gov/pubmed/26861238
http://dx.doi.org/10.1093/aje/kwv299
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