CRE are drug-resistant bacteria that have a mortality rate of up to 50% in those infected. Several clusters of CRE have been detected in Illinois, often in long-term acute care hospitals. In response, Illinois created the XDRO registry, a mandatory reporting system designed to aid inter-facility communication concerning CRE.
Despite being a high priority for control in the US, the case definition for CRE has been the subject of debate3. There are over 70 Enterobacteriaceae which can have different mechanisms of carbapenem resistance. Criteria for carbapenem resistance include susceptibility results and phenotypic or genotypic detection. The case definition for the XDRO registry is intentionally more exclusive (specific) than that used by CSTE (Table 1). CSTE utilizes a definition designed to maximize sensitivity. Illinois’ XDRO registry’s definition is more specific, meant to reduce unnecessary adoption of contact precautions and the negative consequences some patients may experience.
Currently, case reporting to the XDRO registry is a manual data entry process, which has important advantages. However, transitioning to automatic ELR integration will streamline the reporting process and minimize data entry effort. Unfortunately, the clinical information needed to investigate XDROs is often not captured by ELR. The eCR is a new message type being piloted in Illinois that contains many clinical data elements. We examined the feasibility of combining ELR and eCR into reports for the XDRO registry. In the construction of these reports, we examined the impact of using CRE definitions from CSTE and the XDRO registry.
Objective
To streamline carbapenem-resistant enterobacteriaceae (CRE) surveillance by integrating electronic laboratory reporting (ELR) data and electronic case reports (eCR) automatically into Illinois’ extensively drug-resistant organism (XDRO) registry.