Impact of Varying Federal Definitions on Prevalence and Characteristics Associated with Carbapenem-Resistant Enterobacteriaceae (CRE) in Veterans with Spinal Cord Injury

Am J Infect Control, 2019 · DOI: 10.1016/j.ajic.2018.08.001 · Published: February 1, 2019

Spinal Cord Injury Immunology Public Health

Simple Explanation

This study examines the impact of different definitions of carbapenem-resistant Enterobacteriaceae (CRE) on its prevalence among Veterans with spinal cord injuries (SCI). The study compares CRE prevalence based on old and new definitions from both the Centers for Disease Control (CDC) and the Department of Veterans Affairs (VA). The researchers analyzed bacterial cultures from Veterans with SCI to determine how varying definitions affect CRE identification and prevalence estimates.

Study Duration

2012-2013

Participants

6,974 Veterans with SCI

Evidence Level

Retrospective cohort study

Key Findings

1
CRE prevalence varied based on the definition used, with definitions including ertapenem resistance leading to higher prevalence.
2
The South region had the greatest number of CRE patients, and most CRE isolates were identified in high complexity, urban VA medical centers.
3
A significant proportion of CRE cases were identified at VA facilities without specialized SCI centers, indicating a broader impact across different types of facilities.

Research Summary

This retrospective cohort study assessed the impact of varying federal definitions of CRE on its prevalence and characteristics among Veterans with SCI. The study found that CRE prevalence varied depending on the definition used, with the inclusion of ertapenem resistance significantly affecting prevalence estimates. The findings highlight the importance of standardized and accurate CRE definitions for effective surveillance and infection control, particularly in high-risk populations like Veterans with SCI.

Practical Implications

Improved Surveillance

Standardized CRE definitions are needed to ensure accurate surveillance and tracking of CRE infections, particularly in vulnerable populations.

Targeted Interventions

Understanding the impact of different definitions can help healthcare facilities target infection prevention and control resources more effectively.

Clinical Practice

The study underscores the need for clinicians to be aware of the different CRE definitions and their implications for diagnosis and treatment decisions.

Study Limitations

1
The study did not distinguish between CRE infection and colonization.
2
Potential changes in bacterial susceptibility reporting in individual VA microbiology labs during the study period.
3
Microbiology cultures collected outside the VA were not included.

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