Statewide Surveillance Directs Prevention for Carbapenem-Resistant Enterobacteriaceae Efforts

In 2011, the Colorado Department of Public Health and Environment (CDPHE) began work to determine the most effective way to understand the extent of CRE in Colorado. CDPHE did the following:

• Administered an online survey to Colorado laboratories to assess methods used to detect CRE and to obtain preliminary data on the prevalence of CRE in Colorado. Resulting estimates indicated that Colorado might have as many as several hundred cases of CRE each year. However, survey responses also indicated that in some cases, the definition of CRE was not well understood and thus CRE cases were likely over-reported in the survey. Therefore, estimates were likely high.
• Created a working group of physicians, infection control experts, pharmacists, and public health officials to determine the best next steps for detecting and preventing the transmission of CRE. The group determined that more information was needed about the prevalence of CRE in the state and that this information should be gathered systematically.
• Engaged health-care facilities, providers, and laboratories in the process of making CRE a reportable condition in Colorado. The process increased awareness of the public health importance of CRE.

In August 2012, an acute care hospital in Colorado detected an outbreak of CRE. The hospital, aware of efforts to make CRE reportable, notified CDPHE about the outbreak. An investigation by hospital, CDPHE, and CDC staff identified eight patients with a type of CRE rarely seen in the United States. Staff used CDC recommendations about CRE control to contain the outbreak and prevent more patients from acquiring CRE.

On November 30, 2012, Colorado made CRE infection (E. coli, Klebsiella, and Enterobacter) a reportable condition, enabling better surveillance and detection of outbreaks. For each case of CRE reported, surveillance staff members at CDPHE contact the affected health-care facility to educate providers about CRE prevention measures (i.e., using gloves and gowns when caring for patients with CRE, screening other patients for CRE, and improving communication between facilities when transferring patients with CRE). As a result, outbreaks are now detected much sooner, allowing public health authorities to help facilities contain them more quickly.

To further support health-care facilities, CDPHE

• Has made two types of CRE testing available at the state public health laboratory: 1) general CRE screening and 2) specialized testing for types of CRE
• Has developed CRE educational brochures for health-care workers and patients
• Will disseminate data on reported CRE cases to educate health-care providers, public health personnel, and the public.