Quantifying The Burden Of Contact Precautions Of Carbapenem-Resistant Enterobacteriaceae (cre) In Hospital Settings

Carolyn Park

This thesis is restricted to Yale network users only. It will be made publicly available on 02/28/2020


Carbapenem-resistant Enterobacteriaceae (CRE) are a group of multi-drug resistant organisms (MDROs) that is currently considered an important and urgent public health concern due to their high mortality rates, antibiotic resistance, and their potential for rapid transmission. These pathogens are more commonly seen in healthcare-associated infections with some also occurring in the community. This study focused on distinguishing CRE into two distinct groups based on resistance mechanism: carbapenemase-producing CRE (CP-CRE) and non-CP-CRE. In order to determine if testing for carbapenemase can be useful in infection prevention, we aimed to quantify the total hospitalization in days per patient within a 90-day follow-up period after carbapenemase test results were available for both of the CP-CRE and non-CP-CRE patient groups, using the statewide hospitalization and CRE surveillance data from the 2017 calendar year, provided by the Connecticut Hospital Association and the Connecticut Department of Public Health (CT DPH). The study sample consisted of a total of 126 patients (32 CP-CRE, 94 non-CP-CRE). Adjusting for age and sex, we found that CP-CRE patients had 31.6% fewer hospitalization days than non-CP-CRE patients (P<0.0001). We also found that the number of distinct hospitalizations per patient in each group while controlling for age and sex was not statistically significant (P=0.3250). Our results suggest that carbapenemase testing can be informative in possibly guiding treatment or cohorting patients, but further studies with a greater sample size and addressing the limitations of this study need to be conducted for improved interpretations.