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Improving containment and prevention strategies using a patient transfer network representative of patients with
Rany Octaria1,2, Stephen Deppen3, Allison Chan2
1Vanderbilt Epidemiology Ph.D. Program, Vanderbilt University Graduate School, Nashville, TN, USA.
Objectives:
Interfacility patient transfers contribute to the regional spread of multidrug-resistant organisms (MDROs). We evaluated whether transfer patterns of inpatients with similar characteristics to carbapenem-resistant Enterobacterales (CRE) case-patients (CRE surrogates) better reflect hospital-level CRE burden than traditionally used populations.
Design:
We determined the risk factors for subsequent hospital admission using demographic and clinical information from Tennessee Department of Health tracked CRE case-patients from July 2015 to September 2019. Risk factors were used to identify CRE surrogates among inpatients in the 2018 Tennessee Hospital Discharge Data System (HDDS). Transfer networks of CRE surrogates, Medicare/TennCare beneficiaries, and all-inpatients with ≤365 days of intervening community stays were compared with the transfer networks of CRE case-patients in 2019. The associations between hospital-level CRE prevalence and hospitals' incoming transfer volumes from each network were assessed using negative binomial regression models.
Results:
Eight risk factors for subsequent hospital admission were identified from 2,518 CRE case-patients, which were used to match CRE case-patients with HDDS inpatients, resulting in 10,069 surrogate patients. CRE surrogate network showed more structural similarities with the CRE case-patient network than with the all-inpatient and Medicare/TennCare networks. A 33% increase in hospitals' CRE prevalence in 2019 was associated with each doubling of incoming transfer of CRE surrogates in 2018 (adjusted Risk Ratio [aRR] 1.33, 95%CI: 1.1, 1.59), higher than all-inpatient (aRR 1.27, 95% CI: 1.08, 1.51) and Medicare/TennCare networks (aRR 1.21, 95% CI: 1.02, 1.44).
Conclusions:
Surrogate transfer patterns were associated with hospital-level CRE prevalence, highlighting their value in MDRO containment and prevention.
Insights
Identifying carbapenem-resistant Enterobacterales (CRE) surrogates through patient transfer patterns can help track multidrug-resistant organism (MDRO) spread. This approach better reflects hospital CRE burden for effective containment and prevention strategies.
Area of Science:
- Infectious Diseases
- Epidemiology
- Public Health
Background:
- Interfacility patient transfers facilitate the spread of multidrug-resistant organisms (MDROs).
- Carbapenem-resistant Enterobacterales (CRE) pose a significant public health threat due to limited treatment options.
- Accurate tracking of CRE transmission is crucial for effective containment.
Purpose of the Study:
- To evaluate if transfer patterns of CRE surrogates better represent hospital-level CRE burden compared to traditional methods.
- To identify risk factors for subsequent hospital admission among CRE case-patients.
- To assess the association between hospital CRE prevalence and incoming transfer volumes of different patient groups.
Main Methods:
- Identified risk factors for hospital admission from CRE case-patients.
- Used risk factors to define CRE surrogates in the Tennessee Hospital Discharge Data System.
- Compared transfer networks of CRE surrogates, Medicare/TennCare beneficiaries, and all inpatients with CRE case-patients.
- Employed negative binomial regression to analyze associations between hospital CRE prevalence and transfer volumes.
Main Results:
- Eight risk factors identified, leading to 10,069 CRE surrogate patients.
- The CRE surrogate network closely mirrored the CRE case-patient network structure.
- A 33% increase in hospital CRE prevalence was linked to each doubling of incoming CRE surrogate transfers (aRR 1.33).
- CRE surrogate transfers showed a stronger association with CRE prevalence than all-inpatient or Medicare/TennCare transfers.
Conclusions:
- Transfer patterns of CRE surrogates effectively reflect hospital-level CRE burden.
- This surrogate approach offers a valuable tool for MDRO containment and prevention efforts.
- Optimizing patient transfer monitoring can enhance public health strategies against resistant organisms.
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