@article{Rehman_Shaikh_Muhetaer_Khuwaja_2017, title={Carbapenem Resistant Enterobacteriaceae infections in Houston, Texas: An outline}, volume={9}, url={https://ojphi.org/ojs/index.php/ojphi/article/view/7677}, DOI={10.5210/ojphi.v9i1.7677}, abstractNote={<div style="left: 72px; top: 251.273px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.08137);" data-canvas-width="51.022666666666666">Objective</div><div style="left: 84px; top: 263.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02171);" data-canvas-width="303.32759999999996">To examine demographic as well as clinical characteristics of the</div><div style="left: 72px; top: 276.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00443);" data-canvas-width="314.9215999999999">Carbapenam Resistant Enteriobacteriacae (CRE) Organisms cases in</div><div style="left: 72px; top: 289.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00798);" data-canvas-width="125.91333333333336">Houston, Texas, 2015-2016</div><div style="left: 72px; top: 315.273px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.11794);" data-canvas-width="66.10733333333333">Introduction</div><div style="left: 84px; top: 327.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00747);" data-canvas-width="300.0069333333332">According to CDC, CRE is used to describe bacteria that are non-</div><div style="left: 72px; top: 340.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.988221);" data-canvas-width="316.3790666666669">susceptible to one or more carbapenems; doripenem, meropenem</div><div style="left: 72px; top: 353.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.980531);" data-canvas-width="316.04133333333334">or imipenem and resistant to third generation cephalosporins like</div><div style="left: 72px; top: 367.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00954);" data-canvas-width="316.87886666666697">ceftriaxone, cefotaxime and ceftazidime. These organisms cause</div><div style="left: 72px; top: 380.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00581);" data-canvas-width="314.93519999999995">infections that are associated with high mortality rates and they have</div><div style="left: 72px; top: 393.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.988662);" data-canvas-width="316.32240000000013">the potential to spread widely. Antibiotic resistant bacteria cause</div><div style="left: 72px; top: 407.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0154);" data-canvas-width="315.17886666666664">more than 2 million illnesses and at least 23,000 deaths each year in</div><div style="left: 72px; top: 420.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.992505);" data-canvas-width="314.6076666666666">United States. CREs are found in many health care settings like acute</div><div style="left: 72px; top: 433.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.998032);" data-canvas-width="314.69606666666675">care hospitals, long term care facilities, nursing homes, rehabilitation</div><div style="left: 72px; top: 447.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04407);" data-canvas-width="315.84753333333333">facilities and other health care settings. Although CREs includes a</div><div style="left: 72px; top: 460.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.962414);" data-canvas-width="312.2231333333333">number of species, reporting in State of Texas is limited to CRE-</div><div style="left: 72px; top: 473.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00294);" data-canvas-width="45.967999999999996">Klebsiella</div><div style="left: 117.959px; top: 473.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00176);" data-canvas-width="83.41333333333333">species and CRE-</div><div style="left: 201.365px; top: 473.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0028);" data-canvas-width="26.758">E.coli</div><div style="left: 228.116px; top: 473.901px; font-size: 11.3333px; font-family: serif;">.</div><div style="left: 72px; top: 499.273px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.07312);" data-canvas-width="46.59133333333333">Methods</div><div style="left: 84px; top: 511.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00553);" data-canvas-width="302.8980666666667">Population-based surveillance data was generated from Houston’s</div><div style="left: 72px; top: 524.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.977404);" data-canvas-width="316.2226666666668">electronic disease surveillance system reported to Houston Health</div><div style="left: 72px; top: 537.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.980132);" data-canvas-width="316.32126666666653">Department (HHD) from October 2015 to July 2016. Descriptive</div><div style="left: 72px; top: 551.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.05223);" data-canvas-width="318.00086666666664">analysis was performed to examine demographic and clinical</div><div style="left: 72px; top: 564.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00098);" data-canvas-width="314.6926666666666">characteristics across different age groups, gender and race/ethnicity.</div><div style="left: 72px; top: 577.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02649);" data-canvas-width="315.4395333333333">HHD has received a total of 463 CRE cases during the time period,</div><div style="left: 72px; top: 591.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.990697);" data-canvas-width="316.9570666666665">out of which 72 were non-reportable and did not meet the case</div><div style="left: 72px; top: 604.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0192);" data-canvas-width="315.3409333333334">criteria, 187 were out of jurisdiction. The remaining 204 cases were</div><div style="left: 72px; top: 617.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00994);" data-canvas-width="100.11866666666668">included in this study.</div><div style="left: 72px; top: 643.273px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.08488);" data-canvas-width="40.93600000000001">Results</div><div style="left: 84px; top: 655.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04473);" data-canvas-width="303.52933333333357">Out of a total of 204 cases, males and females were represented</div><div style="left: 72px; top: 668.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0213);" data-canvas-width="317.40246666666656">equally (50% each). The mean age of the cases was 67 years</div><div style="left: 72px; top: 681.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01322);" data-canvas-width="315.1119999999999">(age ranges from 22-98). Majority of the cases were in the older age</div><div style="left: 72px; top: 695.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04303);" data-canvas-width="315.7421333333333">group, 70 years and above 53 (26%), followed by 48 (24%) in age</div><div style="left: 72px; top: 708.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03208);" data-canvas-width="315.67753333333303">group 80 and above years. Among the different race/ethnic groups,</div><div style="left: 72px; top: 721.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00498);" data-canvas-width="316.7689333333335">African-Americans comprised of 82 (40%), followed by Whites</div><div style="left: 72px; top: 735.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.969504);" data-canvas-width="316.3813333333336">67 (33%) and Hispanics 33 (16%). Out of 204 cases, 156 (76%)</div><div style="left: 72px; top: 748.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.997955);" data-canvas-width="316.65106666666657">were hospitalized, which included acute care hospital, long-term</div><div style="left: 72px; top: 761.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00859);" data-canvas-width="315.01566666666656">acute care or nursing home. Out of 156 hospitalized cases, 71 (34%)</div><div style="left: 72px; top: 775.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04917);" data-canvas-width="315.87019999999984">were in Intensive Care Unit (ICU) and 136 (67%) had an invasive</div><div style="left: 72px; top: 788.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.982606);" data-canvas-width="264.9268666666667">or indwelling device. Of all the cases, 80% had CRE</div><div style="left: 336.864px; top: 788.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02694);" data-canvas-width="49.97773333333334">Klebsiella</div><div style="left: 72px; top: 801.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00176);" data-canvas-width="55.397333333333336">pneumoniae</div><div style="left: 127.394px; top: 801.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.995461);" data-canvas-width="259.301">, followed by 11% who had CRE- E coli. The cases were</div><div style="left: 72px; top: 815.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0098);" data-canvas-width="315.0734666666666">distributed evenly across the city when plotted on ArcGIS with their</div><div style="left: 72px; top: 828.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00219);" data-canvas-width="96.31066666666666">residential addresses.</div><div style="left: 72px; top: 853.94px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.10259);" data-canvas-width="68.01133333333334">Conclusions</div><div style="left: 84px; top: 865.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.989282);" data-canvas-width="302.5388">CRE cases are found to be more common among older age groups,</div><div style="left: 72px; top: 879.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02285);" data-canvas-width="315.5313333333332">African American population and in hospitalized patients. CRE can</div><div style="left: 72px; top: 892.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01471);" data-canvas-width="315.2026666666666">be a ground for increasing infectious diseases in the community and</div><div style="left: 72px; top: 905.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04494);" data-canvas-width="315.78179999999975">one of the reason may be unnecessary use of antimicrobial agents.</div><div style="left: 72px; top: 919.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.991022);" data-canvas-width="314.53399999999993">This study provides a glimpse into the number of CRE cases reported</div><div style="left: 72px; top: 932.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.965323);" data-canvas-width="316.1433333333332">in Houston since CREs are classified a separate disease in Texas.</div><div style="left: 72px; top: 945.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.986553);" data-canvas-width="314.1679333333334">Further studies are needed to explore the occurrence of anti-microbial</div><div style="left: 72px; top: 959.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.956922);" data-canvas-width="315.7682">drug resistance among the specific population groups and how the</div><div style="left: 72px; top: 972.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00373);" data-canvas-width="290.4959999999999">case investigation efforts can be targeted to enhance prevention.</div>}, number={1}, journal={Online Journal of Public Health Informatics}, author={Rehman, Hafeez and Shaikh, Imran and Muhetaer, Kasimu and Khuwaja, Salma}, year={2017}, month={May} }