1. Robynn Cheng Leidig, MPH
Tackling the Nightmare Bacteria Carbapenem-Resistant Enterobacteriaceae (CRE)—Mandatory Reporting and Development of the Extensively Drug-Resistant Organism (XDRO) Registry in Illinois
Robynn Cheng Leidig, MPH
2012 PHPS Fellow
Office for State, Tribal, Local and Territorial Support
Centers for Disease Control and Prevention
2015 PHAP/PHPS Summer Seminar
June 2, 2015
Presenters that do not want to use the CDC 24/7 cover, can use the basic title slide with lockup.
Note—There are only three acceptable options for text in the lockup bars:
Option 1—Use this if the presentation is a collaboration with other CIOs
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Option 2—Standard choice for the majority of OSTLTS presentations
Office for State, Tribal, Local and Territorial Support
Option 3—Use if presentation is specific to a division or office within OSTLTS
<insert office or division name only—branch names are not acceptable per CDC guidelines>
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support

2. BACKGROUND

3. Carbapenem Resistant Enterobacteriaceae What is CRE? Deadly infection
Few treatment options (if any)
Spreading quickly

4. CRE colonization prevalence
CRE in Illinois
First recognized in Chicago area in December 2007
Chicago area facilities (REALM project),
Facility type
CRE colonization prevalence
Short stay acute care hospitals (adult ICUs) 3%
Long term acute care hospitals (LTACHs)
30%
Lin MY et al. CID, 2013
Few prevalence data existed for hospital non-ICU wards, nursing homes, and regions outside of Chicago

5. METHODS XDRO Registry Development
What did we do? Create the XDRO registry! Now I am going to get into the details of how the registry was created.

6. Present… Illinois Department of Public Health (IDPH)
the Chicago CDC Prevention Epicenter and Medical Research Analytics and Informatics Alliance (MRAIA)
Present…
the Extensively Drug-Resistant Organism (XDRO) registry
Collaboration between IDPH, CDC Prevention Epicenter, MRAIA
Input from HAI Advisory council, other key stakeholders
Amendment to the Control of Communicable Diseases Code (77 Ill. Adm. Code 690) Rules

7. The XDRO registry addresses 2 critical gaps
1. Need improved inter-facility communication
Allows for CRE information exchange
2. Lack of a surveillance system
Stores CRE surveillance data
Make it clear that the XDRO registry is not just a surveillance system (otherwise could have used INEDSS)
Registry is a bi-directional, inter-operable patient record sharing system
Part of a larger vision for PH-HC integration, which is an important component of ACA and CDC’s strategic initiatives
Surveillance important at a facility, regional, and state level

8. Patient admit (Unknown CRE status)
CRE identified
Providers
Laboratories
Report
XDRO registry
Query
- Different from INEDSS
Isolation Precautions (Y/N)
Patient admit (Unknown CRE status)

9. Results

10. CRE Reporting in Illinois
How to report: Extensively Drug-Resistant Organism (XDRO) Registry Began: November 1, 2013 Required to report: Acute care hospitals Long-term acute care hospitals Long-term care facilities Laboratories
XDRO registry is a system for CRE reporting
Part of the state’s CRE Detect and Protect efforts.
Registry implementation happening concurrently with the educational campaign

11. Unique patients reported to XDRO registry
Mandatory reporting
- (Numbers taken from XDRO dashboard): unique # of patients reported into the XDRO registry, by culture date. *potential * CRE cases.
2013

12. XDRO Registry: aggregate data (Nov 1, 2013 – May 13, 2015)
Number of unique patients since November 1st:
1,725
Number of unique facilities that:
have access to the registry
550
have submitted reports
151
have ever queried
127
Total number of queries that have been made:
2,522
Number of unique patients since November 1st: a patient is only included once even if they have multiple CRE reports 
Number of facilities that have access to the registry: includes nearly all of the hospitals in the state
Number of unique facilities that have submitted reports: is the number of facilities that are (potentially) detecting CRE. Some of these could include duplicate reports.
Number of unique facilities that have ever queried: this is every facility that performed at least one query.
(Not on slide)- Number of unique users have logged in: 286

13. Accessing CRE/ XDRO Data
Facilities
Local Health Depts.

14. CRE and XDRO education 30 stakeholder CRE Taskforce
6 webinars: 605 people
2 packets: 470 facilities
2 websites
1 Press release

15. Challenge Steps taken… Ensuring secure access to the XDRO registry
All users must register via IDPH web portal
Coordinating among various agencies and key players
Meetings, phone calls, internal webinars
Developing consistency in facility identifiers
Integrating with existing systems (I-NEDSS)
Meeting both clinical and public health needs
Input from public health and clinical stakeholders
 Engaging labs: Illinois Society for Microbiology
Understanding surveillance criteria & reporting rules: built logic checks into the registry to improve data quality
Understanding surveillance criteria & reporting rules
Webinars, educational materials, consultations, registry improvements

16. Implications Long-term impact Earlier detection of CRE+ patients
Better infection control: 63% (N=203) took ≥1 infection control action as a result of the webinars/ presentations
Reduced spread of CRE in the region?
Source: CDC Vital Signs, March 2013

17. For more information visit: www.xdro.org Robynn Cheng Leidig, MPH
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support

18. EXTRA slides for questions

19. CRE surveillance definition (adapted from CDC CRE toolkit)
Reporting facilities shall report CRE based on laboratory test results:
1. Molecular test (e.g., PCR) specific for carbapenemase OR
2. Phenotypic test (e.g., Modified Hodge) specific for carbapenemase production
3. Susceptibility tests (for E. coli and Klebsiella species only): non-susceptible to ONE of the carbapenems (doripenem, meropenem, or imipenem) AND resistant to ALL third generation cephalosporins tested (ceftriaxone, cefotaxime, and ceftazidime). Ignore ertapenem.
- More details on what is supposed to get reported…

20. Resistance mechanisms reported to XDRO registry
Denominator is unique patients ever reported to the registry
60% of patient reports have a reported mechanism, 40% have an unreported/ unknown mechanism
n=407
n=36
n=22
Not reported/ Unknown: 312 (40% of total patients)

21. System Maturation *
- How INEDSS will be integrated with CRE

22. Cluster Detection SaTScan: Spacial scanning software
Arcview GIS: Provides graphical display