Skip Navigation

Spread of Carbapenem-Resistant Enterobacteriaceae Among Illinois Healthcare Facilities: The Role of Patient Sharing

  1. William E. Trick2,3
  1. 1Division of Patient Safety and Quality, Illinois Department of Public Health
  2. 2Rush University Medical Center
  3. 3Cook County Health and Hospitals System, Chicago, Illinois
  1. Correspondence: M. J. Ray, 122 S Michigan Ave, 7th flr, Chicago, IL 60603 (michael.j.ray{at}illinois.gov).

Abstract

Background. Carbapenem-resistant Enterobacteriaceae (CRE) spread regionally throughout healthcare facilities through patient transfer and cause difficult-to-treat infections. We developed a state-wide patient-sharing matrix and applied social network analyses to determine whether greater connectedness (centrality) to other healthcare facilities and greater patient sharing with long-term acute care hospitals (LTACHs) predicted higher facility CRE rates.

Methods. We combined CRE case information from the Illinois extensively drug-resistant organism registry with measures of centrality calculated from a state-wide hospital discharge dataset to predict facility-level CRE rates, adjusting for hospital size and geographic characteristics.

Results. Higher CRE rates were observed among facilities with greater patient sharing, as measured by degree centrality. Each additional hospital connection (unit of degree) conferred a 6% increase in CRE rate in rural facilities (relative risk [RR] = 1.056; 95% confidence interval [CI], 1.030–1.082) and a 3% increase among Chicagoland and non-Chicago urban facilities (RR = 1.027; 95% CI, 1.002–1.052 and RR = 1.025; 95% CI, 1.002–1.048, respectively). Sharing 4 or more patients with LTACHs was associated with higher CRE rates, but this association may have been due to chance (RR = 2.08; 95% CI, .85–5.08; P = .11).

Conclusions. Hospitals with greater connectedness to other hospitals in a statewide patient-sharing network had higher CRE burden. Centrality had a greater effect on CRE rates in rural counties, which do not have LTACHs. Social network analysis likely identifies hospitals at higher risk of CRE exposure, enabling focused clinical and public health interventions.

Key words

  • Received December 14, 2015.
  • Accepted June 2, 2016.
| Table of Contents

Published on behalf of

cid cover HIV Medicine Association Logo

Society Members: For your free access to this journal, log in via the IDSA members area.

Impact Factor: 8.886

5-Yr impact factor: 9.206

For Reviewers

Looking for your next opportunity?

Looking for jobs...

For the Media

Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.