Emergence of carbapenem-resistant Enterobacteriaceae in Orange County, California, and support for early regional strategies to limit spread
Emergence of carbapenem-resistant Enterobacteriaceae in Orange County, California, and support for early regional strategies to limit spread
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DOI：
10.1016/j.ajic.2017.06.004
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发表时间：
2017-11-01
影响因子：
4.9
通讯作者：
Huang, Susan S.
中科院分区：
文献类型：
--
作者：
Gohil, Shruti K.;Singh, Raveena;Huang, Susan S.
背景：碳青霉烯耐药肠杆菌科（CRE）的东向西传播为探索限制非流行地区传播的策略提供了机会。我们评估了CRE的出现和对遏制战略的区域支持。方法：2014年1月至9月，对加利福尼亚州奥兰治县（31家医院，服务300万居民）的感染预防项目进行了17个问题的横断面调查。问题涉及新发现的医院和社区发病的CRE培养（2008-2013年），当前的CRE控制策略，以及对假设区域干预的预防策略的支持。结果：31家医院中，有21家（68%）完成了调查，代表17个感染预防项目。2009-2010年间几乎没有检测到CRE；在4年内，90%的医院报告了CRE，社区发病比医院发病的CRE高2.5倍。2011年至2013年间，CRE的年发病率增加了4.7倍（1.4-6.3例/ 10000例）。对区域CRE预防包的支持是一致的。虽然22%的患者使用葡萄糖酸氯己定治疗CRE阳性，11%的患者积极筛查CRE，但分别有86%和57%的患者会在区域干预中考虑这些策略。结论：橙县的CRE流行病学与目前流行地区的早期进展相似，这是考虑干预措施以防止流行传播的机会。许多设施将考虑在区域合作的情况下采取积极主动的战略，例如氯己定洗浴。(C)感染控制与流行病学专业人员协会，2017；Elsevier Inc.出版。版权所有。
Background: The east-to-west spread of carbapenem-resistant Enterobacteriaceae (CRE) represents an opportunity to explore strategies to limit spread in nonendemic areas. We evaluated CRE emergence and regional support for containment strategies.Methods: A 17-question cross-sectional survey was administered to infection prevention programs in Orange County, CA (31 hospitals serving 3 million residents), between January and September 2014. Questions addressed newly detected hospital-and community-onset CRE cultures (2008-2013), current CRE control strategies, and support for prevention strategies for a hypothetical regional intervention.Results: Among 31 hospitals, 21 (68%, representing 17 infection prevention programs) completed the survey. CRE was scarcely detected between 2009-2010; within 4 years, 90% of hospitals reported CRE, with 2.5-fold higher community-onset than hospital-onset CRE. Between 2011 and 2013, annual CRE incidence increased 4.7-fold (1.4-6.3 cases/10,000 admissions). Support for a regional CRE prevention bundle was unanimous. Although 22% bathed patients positive for CRE with chlorhexidine gluconate and 11% actively screened for CRE, 86% and 57%, respectively, would consider these strategies in a regional intervention.Conclusions: CRE epidemiology in Orange County parallels early progression previously seen in now-endemic areas, representing an opportunity to consider interventions to prevent endemic spread. Many facilities would consider proactive strategies, such as chlorhexidine bathing, in the setting of a regional collaborative. (C) 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.