In the Journals

Frequent patient sharing increases hospitals' risk for CRE

Interconnected health care facilities employing patient sharing programs appear to have an increased burden of carbapenem-resistant Enterobacteriaceae, according to a recent networking analysis.

“Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly prevalent [extensively drug-resistant organisms (XDROs)] associated with up to 50% mortality in infected persons,” Michael J. Ray, MPH, health systems integration program fellow at the Illinois Department of Public Health, and colleagues wrote.

“Assessing a given hospital’s risk of CRE exposure is critical to targeting surveillance and prevention efforts. Such risk may be driven by patterns of patient movement throughout the health care network.”

Ray and colleagues obtained CRE case data reported by Illinois short- and long-term acute care hospitals during 2014 from state registries. By examining admissions and discharges, they constructed a social network able to track patient movement and quantify the interconnectedness of each health care facility. The researchers analyzed this network for potential relationships with CRE incidence, and adjusted their findings for facility size and geographic influences.

More than half of the 185 included hospitals reported at least one CRE case during 2014, for an overall average of 3.5 cases per hospital. Case rates were similar between men and women, and primarily occurred among blacks (44%) or non-Hispanic whites (43%). There was an average of 64 patient-sharing connections per facilities (range, 1-145).

The researchers’ adjusted, multivariable model found greater patient sharing, as measured by hospital degree centrality, was an independent predictor of a hospital’s CRE rate. Each additional connection at a rural facility increased the burden by approximately 6% (RR = 1.056; 95% CI, 1.030-1.082), and by approximately 3% among urban facilities located inside of Chicagoland (RR = 1.027; 95% CI, 1.002-1.052) and out (RR = 1.025; 95% CI, 1.002-1.048). Although sharing at least four patients with a long-term acute care hospital was associated with increased CRE rates in the bivariate analysis, this relationship was weaker in the full adjusted model (RR= 2.08; 95% CI, 0.85-5.08).

Along with identifying the impact of patient sharing on XDRO burden, Ray and colleagues suggested that this study could be used as a model for other public health systems to measure the risk for CRE in their own area’s hospitals.

“Our work shows that by using widely available patient-sharing data, hospitals and public health officials can identify which facilities are at hightest risk of CRE exposure,” the researchers wrote. “There is urgency for such analyses in order to intervene early and prevent the spread of XDROs.” – by Dave Muoio

Disclosure: The researchers report no relevant financial disclosures.

Interconnected health care facilities employing patient sharing programs appear to have an increased burden of carbapenem-resistant Enterobacteriaceae, according to a recent networking analysis.

“Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly prevalent [extensively drug-resistant organisms (XDROs)] associated with up to 50% mortality in infected persons,” Michael J. Ray, MPH, health systems integration program fellow at the Illinois Department of Public Health, and colleagues wrote.

“Assessing a given hospital’s risk of CRE exposure is critical to targeting surveillance and prevention efforts. Such risk may be driven by patterns of patient movement throughout the health care network.”

Ray and colleagues obtained CRE case data reported by Illinois short- and long-term acute care hospitals during 2014 from state registries. By examining admissions and discharges, they constructed a social network able to track patient movement and quantify the interconnectedness of each health care facility. The researchers analyzed this network for potential relationships with CRE incidence, and adjusted their findings for facility size and geographic influences.

More than half of the 185 included hospitals reported at least one CRE case during 2014, for an overall average of 3.5 cases per hospital. Case rates were similar between men and women, and primarily occurred among blacks (44%) or non-Hispanic whites (43%). There was an average of 64 patient-sharing connections per facilities (range, 1-145).

The researchers’ adjusted, multivariable model found greater patient sharing, as measured by hospital degree centrality, was an independent predictor of a hospital’s CRE rate. Each additional connection at a rural facility increased the burden by approximately 6% (RR = 1.056; 95% CI, 1.030-1.082), and by approximately 3% among urban facilities located inside of Chicagoland (RR = 1.027; 95% CI, 1.002-1.052) and out (RR = 1.025; 95% CI, 1.002-1.048). Although sharing at least four patients with a long-term acute care hospital was associated with increased CRE rates in the bivariate analysis, this relationship was weaker in the full adjusted model (RR= 2.08; 95% CI, 0.85-5.08).

Along with identifying the impact of patient sharing on XDRO burden, Ray and colleagues suggested that this study could be used as a model for other public health systems to measure the risk for CRE in their own area’s hospitals.

“Our work shows that by using widely available patient-sharing data, hospitals and public health officials can identify which facilities are at hightest risk of CRE exposure,” the researchers wrote. “There is urgency for such analyses in order to intervene early and prevent the spread of XDROs.” – by Dave Muoio

Disclosure: The researchers report no relevant financial disclosures.