Spread of Carbapenem-Resistant Enterobacteriaceae Among Illinois Healthcare Facilities: The Role of Patient Sharing.
Spread of Carbapenem-Resistant Enterobacteriaceae Among Illinois Healthcare Facilities: The Role of Patient Sharing.
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DOI：
10.1093/cid/ciw461
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发表时间：
2016-10-01
期刊：
影响因子：
--
通讯作者：
Trick WE
中科院分区：
文献类型：
--
作者：
Ray MJ;Lin MY;Weinstein RA;Trick WE
耐碳青霉烯类肠杆菌科（CRE）通过患者转移在整个医疗机构中区域性传播，并导致难以治疗的感染。我们开发了一个全州范围内的患者共享矩阵，并应用社交网络分析来确定与其他医疗机构的更大连通性（中心性）以及与长期急性护理医院（LTACH）的更大患者共享是否预示着更高的设施CRE率。我们将伊利诺伊州广泛耐药微生物登记处的CRE病例信息与从全州医院出院数据集计算的中心性指标相结合，以预测机构级CRE率，并根据医院规模和地理特征进行调整。较高的CRE率，观察到更多的病人共享的设施，作为衡量的程度中心。每增加一个医院连接（学位单位）在农村设施中提高了6%的CRE率（相对风险[RR] = 1.056; 95%置信区间[CI]，1.030-1.082），芝加哥和非芝加哥城市设施之间增加3%（RR = 1.027; 95%CI，1.002-1.052和RR = 1.025; 95%CI，1.002-1.048）。共享4例或更多LACH患者与更高的CRE率相关，但这种相关性可能是偶然的（RR = 2.08; 95% CI，0.85 -5.08; P = 0.11）。在全州范围的患者共享网络中，与其他医院联系更紧密的医院有更高的CRE负担。中心性对农村县的CRE率有更大的影响，这些县没有LTACHs。社交网络分析可能会识别出CRE暴露风险较高的医院，从而实现集中的临床和公共卫生干预。
Carbapenem-resistant Enterobacteriaceae (CRE) spread regionally throughout healthcare facilities through patient transfer and cause difficult-to-treat infections. We developed a state-wide patient-sharing matrix and applied social network analyses to determine whether greater connectedness (centrality) to other healthcare facilities and greater patient sharing with long-term acute care hospitals (LTACHs) predicted higher facility CRE rates. We combined CRE case information from the Illinois extensively drug-resistant organism registry with measures of centrality calculated from a state-wide hospital discharge dataset to predict facility-level CRE rates, adjusting for hospital size and geographic characteristics. Higher CRE rates were observed among facilities with greater patient sharing, as measured by degree centrality. Each additional hospital connection (unit of degree) conferred a 6% increase in CRE rate in rural facilities (relative risk [RR] = 1.056; 95% confidence interval [CI], 1.030–1.082) and a 3% increase among Chicagoland and non-Chicago urban facilities (RR = 1.027; 95% CI, 1.002–1.052 and RR = 1.025; 95% CI, 1.002–1.048, respectively). Sharing 4 or more patients with LTACHs was associated with higher CRE rates, but this association may have been due to chance (RR = 2.08; 95% CI, .85–5.08; P = .11). Hospitals with greater connectedness to other hospitals in a statewide patient-sharing network had higher CRE burden. Centrality had a greater effect on CRE rates in rural counties, which do not have LTACHs. Social network analysis likely identifies hospitals at higher risk of CRE exposure, enabling focused clinical and public health interventions.
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