By Carol A. Kemper, MD, FACP

Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases, Santa Clara Valley Medical Center

Dr. Kemper discloses no financial relationships relevant to this field of study.

SOURCE: Grabowski ME, et al. Provider role in transmission of carbapenem-resistant Enterobacteriaceae. Infect Control Hosp Epidemiol 2017;38:
1329-1334.

Grabowski et al investigated the provider role in patient-to-patient transmission of carbapenem-resistant Enterobacteriaceae (CRE) in a hospital facility with a robust CRE surveillance program. Between 2011 and 2015, researchers conducted a case-controlled study of patients who acquired CRE during their hospitalization and those who did not. Cases demonstrated negative stool CRE surveillance within 48 hours of admission, with a subsequent positive CRE culture, and a hospital stay of at least nine days.

Controls had two or more negative stool surveillance studies with a similar length of hospital stay (LOS). Patient-provider interactions were documented per day. CRE status was documented in the electronic record, and any patient with a history of CRE was placed in contact isolation with use of gowns and gloves. Hand hygiene was monitored actively, and compliance with hand hygiene was 81%. A total of 121 patients acquired CRE during their hospital stay during the six-year study period. Cases were admitted more commonly to the general surgery/transplant unit, ICU, or burn unit. The median LOS for cases was 49 days compared with 20.5 days for controls. Cases experienced an average 43 ± 8 unique documented provider interactions in one week (an average of 10.5 ± 3 per day) compared with 41 ± 8.7 for controls (an average of 9.5 ± 3 per day).

Case patients were statistically significantly more likely to be cared for by a CRE-shared provider, meaning providers caring for another patient with CRE, than controls. Case patients saw an average of four more shared providers per week than controls. Controlling for age and ICU stay, the odds of a case being exposed to a shared-source provider was 2.27 higher than for controls. Providers caring for a known CRE patient appear to play an active role in patient-to-patient transmission.