Knowing More of the Iceberg: How Detecting a Greater Proportion of Carbapenem-Resistant Enterobacteriaceae (CRE) Carriers Impacts Transmission.


While knowing all carriers provided the most benefits, if not feasible, it may be worthwhile to aim for detecting more than 1 in 5 carriers.

Clinical testing detects a fraction of carbapenem-resistant Enterobacteriaceae (CRE) carriers. Detecting a greater proportion could lead to increased use of infection prevention and control measures but requires resources. Therefore, it is important to understand the impact of detecting increasing proportions of CRE carriers.

We used our Regional Healthcare Ecosystem Analyst-generated agent-based model of adult inpatient healthcare facilities in Orange County, California to explore the impact of detecting greater proportions of carriers on CRE spread.

Detecting and placing 1 in 9 carriers on contact precautions increased prevalence from 0% to 8.0% countywide over 10 years. Increasing the proportion of detected carriers yielded linear reductions in transmission up to detecting 1 in 5 carriers; after this, reductions were greater than linear. Transmission reductions did not occur for 1, 4, or 5 years, varying by facility type. With 70% contact precaution effectiveness, the detection level yielding non-linear reductions remained unchanged; with >80% effectiveness, detecting only 1 in 5 garnered large reductions in CRE carriers. Trends held when CRE was already present in the region.

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Kim Wong

Research Assistant Professor
University of Pittsburgh