West Virginia Carbapenem-resistant Enterobacteriaceae (CRE) Surveillance Report January 1, 2014 – December 31, 2014

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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