Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) are an urgent threat with potential for rapid spread. We evaluated the role of Medicare patient movement between facilities to model the spread of CRE within a region. Through population-based CRE surveillance in the 8-county Atlanta Metropolitan area (population 4.1 million), all Escherichiacoli, Enterobacter spp, or Klebsiella spp. resistant to ≥1 carbapenem collected from urine or a normally sterile site were reported from residents. CRE was attributed to a facility based on timing of culture and facility exposures in the previous year; centrality metrics were calculated from 2016 Medicare data and compared to CRE-transfer derived centrality metrics by Spearman correlation. During 2016, 283 incident CRE cases with concurrent or prior year facility stays were identified; cases were attributed mostly to acute care hospitals (ACH: 141, 50%) and skilled nursing facilities (SNF: 113, 40%), and less frequently to long term acute care hospitals (LTACH: 29, 10%). Attribution was widespread, originating at 17 of 20 ACH (85%), 7 of 8 (88%) LTACH, but only 35 of 65 (54%) SNFs. Betweenness of Medicare patient-transfers strongly correlated with betweenness of CRE case-transfer data in ACHs (r...Continue Reading
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