INTRODUCTION
Enterobacteriaceae are an important cause of community-acquired and healthcare-associated
infections. They cause a wide range of infections, including urinary tract infections, bacteremia,
pneumonia, and wound infections. Carbapenem-resistant Enterobacteriaceae (CRE) infections are very
difficult to treat and are associated with a high mortality rate, up to 50% in some studies.
1
This type of
resistance is spreading, so surveillance for CRE is an important aspect of prevention and control efforts.
Since August 2013, laboratories testing specimens from West Virginia residents have been required to
report cases of CRE to the local health department of the patient’s county of residence within one week
of detection (see 64CSR7 http://apps.sos.wv.gov/adlaw/csr/readfile.aspx?DocId=25071&Format=PDF).
The following surveillance report summarizes data from cases of CRE reported between January 1, 2014
and December 31, 2014.
METHODS
For surveillance purposes, a case of CRE is defined as an Enterobacteriaceae that is nonsusceptible to
one of the following carbapenems: doripenem, meropenem, or imipenem and resistant to all of the
following third-generation cephalosporins that were tested: ceftriaxone, cefotaxime, and ceftazidime
(http://www.cdc.gov/hai/organisms/cre/cre-toolkit/background.html#definition).
Case counts are based on date of report. Each individual case is only counted one time, regardless of
how many lab results are received for this individual. The exception to this is when a single individual is
reported as being infected/colonized with more than one carbapenem-resistant organism.
From January–December 2014, four individuals were diagnosed with two or more separate
carbapenem-resistant organisms. Thus, the data were analyzed two ways: at the organism level (see
Specimen data) and at the patient level (see Demographics). Data were analyzed at the state level and at
the regional level. Variables with 0-4 cases are indicated with a value of “<5” in order to protect patient
confidentiality. When variables have missing data, the number of cases included in the analysis is noted
beside the variable name.
RESULTS
One hundred and thirty-two (132) patients were reported and one hundred thirty-six (136) organisms
were identified. Each individual was counted once and information about the demographics was
collected. Furthermore, a separate list was compiled of the organisms and a variety of organisms were
reported (see Table 1), the most common CREs were Klebsiella pneumoniae and Enterobacter cloacae.
LIMITATIONS
Limitations to this report include the fact that this is a passive surveillance system and some cases may
not be reported, including West Virginia residents who may seek medical care outside of the state. In
addition, neither a true incidence nor a true prevalence can be calculated based on this data; since case
counts are based on laboratory reports, the cases being reported may be newly identified cases of
infection/colonization or they may be known cases being retested for a variety of other reasons. Finally,
the mechanism of resistance for these organisms is unknown.
https://oeps.wv.gov/cre/documents/data/2014_cre_report.pdf