title: Establishment of a statewide network for carbapenem-resistant enterobacteriaceae prevention in a low-incidence region.
abstract: OBJECTIVE
  To establish a statewide network to detect, control, and prevent the spread of carbapenem-resistant Enterobacteriaceae (CRE) in a region with a low incidence of CRE infection.
  
  
  METHODS
  Implementation of the Drug Resistant Organism Prevention and Coordinated Regional Epidemiology (DROP-CRE) Network.
  
  
  METHODS
  Oregon infection prevention and microbiology laboratory personnel, including 48 microbiology laboratories, 62 acute care facilities, and 140 long-term care facilities.
  
  
  METHODS
  The DROP-CRE working group, comprising representatives from academic institutions and public health, convened an interdisciplinary advisory committee to assist with planning and implementation of CRE epidemiology and control efforts. The working group established a statewide CRE definition and surveillance plan; increased the state laboratory capacity to perform the modified Hodge test and polymerase chain reaction for carbapenemases in real time; and administered surveys that assessed the needs and capabilities of Oregon infection prevention and laboratory personnel. Results of these inquiries informed CRE education and the response plan.
  
  
  RESULTS
  Of 60 CRE reported from November 2010 through April 2013, only 3 were identified as carbapenemase producers; the cases were not linked, and no secondary transmission was found. Microbiology laboratories, acute care facilities, and long-term care facilities reported lacking carbapenemase testing capability, reliable interfacility communication, and CRE awareness, respectively. Survey findings informed the creation of the Oregon CRE Toolkit, a state-specific CRE guide booklet.
  
  
  CONCLUSIONS
  A regional epidemiology surveillance and response network has been implemented in Oregon in advance of widespread CRE transmission. Prospective surveillance will determine whether this collaborative approach will be successful at forestalling the emergence of this important healthcare-associated pathogen.
authors.affiliation: Department of Hospital and Specialty Medicine, Portland Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Pfeiffer
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Cunningham
authors.forename: Tasha
authors.initials: T
authors.lastname: Poissant
authors.forename: Jon P
authors.initials: JP
authors.lastname: Furuno
authors.forename: John M
authors.initials: JM
authors.lastname: Townes
authors.forename: Andrew
authors.initials: A
authors.lastname: Leitz
authors.forename: Ann
authors.initials: A
authors.lastname: Thomas
authors.forename: Genevieve L
authors.initials: GL
authors.lastname: Buser
authors.forename: Robert F
authors.initials: RF
authors.lastname: Arao
authors.forename: Zintars G
authors.initials: ZG
authors.lastname: Beldavs
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics / Q000302:isolation & purification; D015780:Carbapenems / Q000494:pharmacology* / Q000627:therapeutic use; D019411:Clinical Laboratory Techniques; D003428:Cross Infection / Q000517:prevention & control; D004352:Drug Resistance, Microbial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000201:enzymology; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D009922:Oregon / Q000453:epidemiology; D011159:Population Surveillance; D060888:Real-Time Polymerase Chain Reaction; D001618:beta-Lactamases / Q000235:genetics / Q000302:isolation & purification
chemical_list: D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase