Cargando…

2481. Comparing inter-hospital patient movement patterns to better understand mechanisms for regional dissemination of carbapenem-resistant Enterobacteriaceae

BACKGROUND: Understanding inter-hospital movement of patients provides insight into regional transmission of multidrug-resistant organisms (MDROs) that can guide containment efforts. Movement of general patient populations are often used for this purpose, but movement of the specific patient populat...

Descripción completa

Detalles Bibliográficos
Autores principales: Wolford, Hannah, O’Hagan, Justin, Paul, Prabasaj, Reddy, Sujan, Attell, Brandon, Jernigan, John A, Slayton, Rachel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809954/
http://dx.doi.org/10.1093/ofid/ofz360.2159
_version_ 1783462126811086848
author Wolford, Hannah
O’Hagan, Justin
Paul, Prabasaj
Reddy, Sujan
Attell, Brandon
Jernigan, John A
Slayton, Rachel
author_facet Wolford, Hannah
O’Hagan, Justin
Paul, Prabasaj
Reddy, Sujan
Attell, Brandon
Jernigan, John A
Slayton, Rachel
author_sort Wolford, Hannah
collection PubMed
description BACKGROUND: Understanding inter-hospital movement of patients provides insight into regional transmission of multidrug-resistant organisms (MDROs) that can guide containment efforts. Movement of general patient populations are often used for this purpose, but movement of the specific patient population of MDRO carriers may be more useful. We sought to compare movement of CRE patients with that of other patient populations to explore whether CRE carriers move differently, and if so, to determine whether administrative data can be used to identify patient populations with transfer patterns that mimic CRE patients. METHODS: We used New York’s Statewide Planning and Research Cooperative System (SPARCS), to create a patient network of all acute care hospital encounters (“overall hospital population”) during 2013–2015. We identified the subset of CRE cases in the network by linking the SPARCS data to CRE cases reported to the National Healthcare Safety Network in 2014, matching on admission date, date of birth, gender, and facility. We described patient characteristics and movement patterns across 3 cohorts: (1) CRE cases, (2) overall hospital population, (3) CRE surrogate (patients clinically similar to CRE cases based on length of stay [LOS] ≥14 days and Clinical Classification Software [CCS] category of sepsis plus at least one of the following additional CCS categories: adult respiratory failure, acute renal failure, procedure complication or device complication). Correlations between cohorts were calculated using patient transfer matrices to determine similarities between the networks. RESULTS: The average LOS for CRE cases was 25× higher than the overall hospital population (31.4 vs. 1.3 days, Figure 1a), and CRE cases were more likely to die or be discharged to a skilled nursing facility (Figure 1b). CRE movement networks were only moderately correlated with the overall hospital population (R(2) = 0.51); there was higher correlation between CRE case and CRE surrogate networks (R(2) = 0.73). CONCLUSION: CRE patients have different healthcare experiences in the hospital and between hospitals in New York compared with the overall hospital population. The CRE surrogate cohort transfer patterns were more similar, and could be used to understand CRE patient movement in the absence of CRE culture data. [Image: see text] DISCLOSURES: All authors: No reported disclosures.
format Online
Article
Text
id pubmed-6809954
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-68099542019-10-28 2481. Comparing inter-hospital patient movement patterns to better understand mechanisms for regional dissemination of carbapenem-resistant Enterobacteriaceae Wolford, Hannah O’Hagan, Justin Paul, Prabasaj Reddy, Sujan Attell, Brandon Jernigan, John A Slayton, Rachel Open Forum Infect Dis Abstracts BACKGROUND: Understanding inter-hospital movement of patients provides insight into regional transmission of multidrug-resistant organisms (MDROs) that can guide containment efforts. Movement of general patient populations are often used for this purpose, but movement of the specific patient population of MDRO carriers may be more useful. We sought to compare movement of CRE patients with that of other patient populations to explore whether CRE carriers move differently, and if so, to determine whether administrative data can be used to identify patient populations with transfer patterns that mimic CRE patients. METHODS: We used New York’s Statewide Planning and Research Cooperative System (SPARCS), to create a patient network of all acute care hospital encounters (“overall hospital population”) during 2013–2015. We identified the subset of CRE cases in the network by linking the SPARCS data to CRE cases reported to the National Healthcare Safety Network in 2014, matching on admission date, date of birth, gender, and facility. We described patient characteristics and movement patterns across 3 cohorts: (1) CRE cases, (2) overall hospital population, (3) CRE surrogate (patients clinically similar to CRE cases based on length of stay [LOS] ≥14 days and Clinical Classification Software [CCS] category of sepsis plus at least one of the following additional CCS categories: adult respiratory failure, acute renal failure, procedure complication or device complication). Correlations between cohorts were calculated using patient transfer matrices to determine similarities between the networks. RESULTS: The average LOS for CRE cases was 25× higher than the overall hospital population (31.4 vs. 1.3 days, Figure 1a), and CRE cases were more likely to die or be discharged to a skilled nursing facility (Figure 1b). CRE movement networks were only moderately correlated with the overall hospital population (R(2) = 0.51); there was higher correlation between CRE case and CRE surrogate networks (R(2) = 0.73). CONCLUSION: CRE patients have different healthcare experiences in the hospital and between hospitals in New York compared with the overall hospital population. The CRE surrogate cohort transfer patterns were more similar, and could be used to understand CRE patient movement in the absence of CRE culture data. [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6809954/ http://dx.doi.org/10.1093/ofid/ofz360.2159 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Wolford, Hannah
O’Hagan, Justin
Paul, Prabasaj
Reddy, Sujan
Attell, Brandon
Jernigan, John A
Slayton, Rachel
2481. Comparing inter-hospital patient movement patterns to better understand mechanisms for regional dissemination of carbapenem-resistant Enterobacteriaceae
title 2481. Comparing inter-hospital patient movement patterns to better understand mechanisms for regional dissemination of carbapenem-resistant Enterobacteriaceae
title_full 2481. Comparing inter-hospital patient movement patterns to better understand mechanisms for regional dissemination of carbapenem-resistant Enterobacteriaceae
title_fullStr 2481. Comparing inter-hospital patient movement patterns to better understand mechanisms for regional dissemination of carbapenem-resistant Enterobacteriaceae
title_full_unstemmed 2481. Comparing inter-hospital patient movement patterns to better understand mechanisms for regional dissemination of carbapenem-resistant Enterobacteriaceae
title_short 2481. Comparing inter-hospital patient movement patterns to better understand mechanisms for regional dissemination of carbapenem-resistant Enterobacteriaceae
title_sort 2481. comparing inter-hospital patient movement patterns to better understand mechanisms for regional dissemination of carbapenem-resistant enterobacteriaceae
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809954/
http://dx.doi.org/10.1093/ofid/ofz360.2159
work_keys_str_mv AT wolfordhannah 2481comparinginterhospitalpatientmovementpatternstobetterunderstandmechanismsforregionaldisseminationofcarbapenemresistantenterobacteriaceae
AT ohaganjustin 2481comparinginterhospitalpatientmovementpatternstobetterunderstandmechanismsforregionaldisseminationofcarbapenemresistantenterobacteriaceae
AT paulprabasaj 2481comparinginterhospitalpatientmovementpatternstobetterunderstandmechanismsforregionaldisseminationofcarbapenemresistantenterobacteriaceae
AT reddysujan 2481comparinginterhospitalpatientmovementpatternstobetterunderstandmechanismsforregionaldisseminationofcarbapenemresistantenterobacteriaceae
AT attellbrandon 2481comparinginterhospitalpatientmovementpatternstobetterunderstandmechanismsforregionaldisseminationofcarbapenemresistantenterobacteriaceae
AT jerniganjohna 2481comparinginterhospitalpatientmovementpatternstobetterunderstandmechanismsforregionaldisseminationofcarbapenemresistantenterobacteriaceae
AT slaytonrachel 2481comparinginterhospitalpatientmovementpatternstobetterunderstandmechanismsforregionaldisseminationofcarbapenemresistantenterobacteriaceae