title: Statewide surveillance of carbapenem-resistant enterobacteriaceae in Michigan.
abstract: BACKGROUND
  Carbapenem-resistant Enterobacteriaceae (CRE) are clinically challenging, threaten patient safety, and represent an emerging public health issue. CRE reporting is not mandated in Michigan.
  
  
  METHODS
  The Michigan Department of Community Health-led CRE Surveillance and Prevention Initiative enrolled 21 facilities (17 acute care and 4 long-term acute care facilities) across the state. Baseline data collection began September 1, 2012, and ended February 28, 2013 (duration, 6 months). Enrolled facilities voluntarily reported cases of Klebsiella pneumoniae and Escherichia coli according to the surveillance algorithm. Patient demographic characteristics, laboratory testing, microbiology, clinical, and antimicrobial information were captured via standardized data collection forms. Facilities reported admissions and patient-days each month.
  
  
  RESULTS
  One-hundred two cases over 957,220 patient-days were reported, resulting in a crude incidence rate of 1.07 cases per 10,000 patient-days. Eighty-nine case patients had test results positive for K. pneumoniae, whereas 13 had results positive for E. coli. CRE case patients had a mean age of 63 years, and 51% were male. Urine cultures (61%) were the most frequently reported specimen source. Thirty-five percent of cases were hospital onset; sixty-five percent were community onset (CO), although 75% of CO case patients reported healthcare exposure within the previous 90 days. Cardiovascular disease, renal failure, and diabetes mellitus were the most frequently reported comorbid conditions. Common ris k factors included surgery within the previous 90 days, recent infection or colonization with a multidrug-resistant organism, and recent exposures to antimicrobials, especially third- or fourth-generation cephalosporins.
  
  
  CONCLUSIONS
  CRE are found throughout Michigan healthcare facilities. Implementing a regional, coordinated surveillance and prevention initiative may prevent CRE from becoming hyperendemic in Michigan.
authors.affiliation: Division of Communicable Diseases, Bureau of Disease Control, Prevention and Epidemiology, Michigan Department of Community Health, Lansing, Michigan.
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Brennan
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Coyle
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
authors.forename: Jason M
authors.initials: JM
authors.lastname: Pogue
authors.forename: Martha
authors.initials: M
authors.lastname: Boehme
authors.forename: Jennie
authors.initials: J
authors.lastname: Finks
authors.forename: Anurag N
authors.initials: AN
authors.lastname: Malani
authors.forename: Kerrie E
authors.initials: KE
authors.lastname: VerLee
authors.forename: Bryan O
authors.initials: BO
authors.lastname: Buckley
authors.forename: Noreen
authors.initials: N
authors.lastname: Mollon
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Sundin
authors.forename: Laraine L
authors.initials: LL
authors.lastname: Washer
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015780:Carbapenems / Q000494:pharmacology / Q000627:therapeutic use*; D016001:Confidence Intervals; D003428:Cross Infection; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D011159:Population Surveillance; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems