Statewide surveillance of carbapenem-resistant Enterobacteriaceae in Michigan

Brenda M. Brennan, Joseph R. Coyle, Dror Marchaim, Jason M. Pogue, Martha Boehme, Jennie Finks, Anurag N. Malani, Kerrie E. VerLee, Bryan O. Buckley, Noreen Mollon, Daniel R. Sundin, Laraine L. Washer, Keith S. Kaye

Research output: Contribution to journalArticlepeer-review


Background. Carbapenem-resistant Enterobacteriaceae (CRE) are clinically challenging, threaten patient safety, and represent an emerging public health issue. CRE reporting is not mandated in Michigan. Methods. The Michigan Department of Community Health-led CRE Surveillance and Prevention Initiative enrolled 21 facilities (17 acute care and 4 long-term acute care facilities) across the state. Baseline data collection began September 1, 2012, and ended February 28, 2013 (duration, 6 months). Enrolled facilities voluntarily reported cases of Klebsiella pneumoniae and Escherichia coli according to the surveillance algorithm. Patient demographic characteristics, laboratory testing, microbiology, clinical, and antimicrobial information were captured via standardized data collection forms. Facilities reported admissions and patient-days each month. Results. One-hundred two cases over 957,220 patient-days were reported, resulting in a crude incidence rate of 1.07 cases per 10,000 patient-days. Eighty-nine case patients had test results positive for K. pneumoniae, whereas 13 had results positive for E. coli. CRE case patients had a mean age of 63 years, and 51% were male. Urine cultures (61%) were the most frequently reported specimen source. Thirtyfive percent of cases were hospital onset; sixty-five percent were community onset (CO), although 75% of CO case patients reported healthcare exposure within the previous 90 days. Cardiovascular disease, renal failure, and diabetes mellitus were the most frequently reported comorbid conditions. Common ris k factors included surgery within the previous 90 days, recent infection or colonization with a multidrug-resistant organism, and recent exposures to antimicrobials, especially third- or fourth-generation cephalosporins. Conclusions. CRE are found throughout Michigan healthcare facilities. Implementing a regional, coordinated surveillance and prevention initiative may prevent CRE from becoming hyperendemic in Michigan.

Original languageEnglish
Pages (from-to)342-349
Number of pages8
JournalInfection Control and Hospital Epidemiology
Issue number4
StatePublished - 2014


FundersFunder number
National Institutes of HealthU50CI000895


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