District of Columbia Creates Citywide Effort to Track Multidrug-Resistant Bacteria

The public health departments of Washington, DC, have recently launched a comprehensive citywide evaluation to gauge the prevalence of the multidrug-resistant Gram-negative bacterium carbapenem-resistant enterobacteriaceae (CRE) in healthcare facilities throughout the district.

Dubbed Healthcare Facility Antibiotic Resistance Prevalence–District of Columbia (HARP–DC), the study is being led by the DC Department of Health, and is funded by the US Centers for Disease Control and Prevention (CDC) under its epidemiology and laboratory capacity for infectious diseases funding program for tracking healthcare-associated infections.

Organizations participating in the study include the District of Columbia Hospital Association (DCHA), Washington, DC, which will coordinate the engagement of its member healthcare facilities; and OpGen Inc, Gaithersburg, Md, which will perform laboratory services for the study. The DC Department of Forensic Sciences–Public Health Laboratory is also participating in the study by providing logistical support and by sequencing and banking isolates recovered from cultures.

Multidrug-resistant organisms (MDROs) are common bacteria that have developed resistance to multiple classes of antibiotics. They are a leading cause of healthcare-acquired infections and are associated with an increase in morbidity and mortality. Each year, more than two million Americans acquire infections that are resistant to antibiotics. Asymptomatic carriers are at a higher risk of an MDRO infection and become reservoirs for transmission to other patients in healthcare systems if not accurately identified early. Since there are many types of antibiotic-resistant organisms, and the way they cause disease is dictated by their genetics, knowing the exact genetic profile of these organisms is a key step toward preventing their ability to infect.

CRE is in a family of bacteria that are normally found in the stomach. The so-called “superbug” is easily transmissible and often resistant to “last resort” antibiotics. According to a global meta-analysis, 40% to 80% of people who develop these potentially untreatable infections will die.¹ Recent outbreaks of CRE have presented challenges for prominent hospitals nationwide, prompting attention from CDC and other public health agencies.

In early August, CDC issued a Vital Signs report explaining that an increasing number of germs are no longer responding to the drugs designed to kill them.² “Inappropriate prescribing of antibiotics and lack of infection control actions can contribute to drug resistance and put patients at risk,” said the report.

“We issued a call to action in a recent report, asking for state and local health departments to safeguard against the spread of multidrug-resistant infections by working with local healthcare facilities,” says Denise Cardo, MD, director of CDC’s division of healthcare quality promotion. “One way to improve the local understanding of resistance is to assess the number of patients with specific drug-resistant infections. The HARP–DC study is an example of a public-private partnership that can improve our knowledge about resistant infections in the nation’s capital through the combined efforts of the city’s health departments, the DCHA, and OpGen.”

The HARP–DC study marks the district’s first effort of its kind for combatting CRE, heeding CDC’s call by bringing together the city’s healthcare providers, public health departments, and industry representatives in a collaborative effort, making use of advanced molecular testing technology.

With coordination by DCHA, healthcare facilities in the district—including acute care, long-term care, and skilled nursing facilities—will participate in the study to better understand the rates of CRE colonization and infection. DCHA member hospitals participating in the study include BridgePoint Hospital (both Capitol Hill and Hadley campuses), Children’s National Medical Center, George Washington University Hospital, Howard University Hospital, Providence Hospital, MedStar Georgetown University Hospital, MedStar Washington Hospital Center, Sibley Memorial Hospital, and United Medical Center.

“We know that individuals in our local healthcare facilities are harboring CRE and are unknowingly at risk,” says Robert Malson, DCHA president. “At this point, while CRE is still a rare event, it can spread outside the gut quickly, particularly in people who are taking antibiotics for other ailments or whose health is in a comprised or weakened state.

“With cooperation from many of our member facilities, our goal with this study is to gain a better understanding about the prevalence of CRE in Washington metropolitan hospitals and skilled nursing facilities,” Malson adds. “With information in hand, we can proactively implement additional safety measures to prevent transmissions and help ensure the health of our patients.”

“We are very pleased to be participating in this important evaluation,” says Glenn Wortmann, MD, chief of the infectious diseases section at MedStar Washington Hospital Center. “Collaboration of this kind will help us gain much greater insights into CRE and, ultimately, we will be better prepared to prevent it in the future—ensuring the safety of our patients.”

OpGen Inc is an early commercial-stage molecular testing and bioinformatics company focused on assisting healthcare providers in combatting MDRO infections by providing a suite of FDA-cleared and CE-marked diagnostics for rapid molecular testing of blood cultures designed to ensure appropriate antibiotic therapy. OpGen will support the HARP–DC study by providing MDRO testing through its clinical laboratory, using its suite of Acuitas MDRO tests and the Acuitas Lighthouse MDRO management system for bioinformatics analysis.

Over several weeks, each participating facility will test patients for 3 days across designated units to determine the CRE threat in the facilities. This step will identify the patient care units that are at the highest risk and allow for heightened infection control measures in those facilities to minimize transmission and prevent outbreaks. During the study, the DC departments of health and forensic sciences will gain real-time surveillance data for the superbug.

“The OpGen team is proud to support this effort with our technology and expertise as a means to help curb this emerging and life-threatening bacteria in our own metropolitan area,” says Evan Jones, OpGen chairman and CEO. “MDROs, including CRE, threaten the welfare of patients and the quality of healthcare provided, as well as create a significant cost burden to healthcare facilities.”

For further information, visit the District of Columbia Hospital Association and OpGen.

REFERENCES

1. Falagas ME, Lourida P, Poulikakos P, Rafailidis PI, Giannoula S, Tansarlia GS. Antibiotic treatment of infections due to carbapenem-resistant enterobacteriaceae: systematic evaluation of the available evidence. Antimicrob Agents Chemother. 2014;58(2):654–663; doi: 10.1128/AAC.01222-13.
2. Making healthcare safer: stop spread of antibiotic resistance. Vital Signs [online]. Atlanta: Centers for Disease Control and Prevention, 2015. Available at: http://www.cdc.gov/vitalsigns/stop-spread/index.html. Accessed November 23, 2015.