Tackling the Nightmare Bacteria Carbapenem-Resistant Enterobacteriaceae (CRE)—Mandatory Reporting and Development of the Extensively Drug-Resistant Organism (XDRO) Registry in Illinois

Background:

CRE are XDROs with few antibiotic treatment options making them both a health care and public health concern. In response to an increase in CRE among hospitalized patients in the Chicago area, the Illinois Department of Public Health (IDPH) sought to improve statewide CRE surveillance and infection control by developing a public health informatics tool.

Methods:

IDPH worked with stakeholders to amend the Control of Communicable Diseases Code, requiring all acute-care hospitals, long-term care facilities, and laboratories to report CRE isolates. The revised code also established the XDRO registry for CRE reporting. With input from end-users, IDPH partnered with the Chicago CDC Prevention Epicenter to develop the registry to allow for both electronic case reporting and bi-directional communication of patients’ CRE status. A secure website was created, and IDPH granted access to all reporting personnel who had existing access to the state’s notifiable electronic disease surveillance system.

 

Results:

The CRE reporting rule and XDRO registry launched on November 1, 2013. To date, 538 facilities have registry access and 344 users have accessed the system. More than 1,400 CRE cases have been reported from 143 facilities, and 115 unique facilities have queried the registry to identify CRE-positive patients. After an initial phase, structural changes to the report form included more required fields, logic checks, and pop-up windows to guide the user. Six webinars on CRE control and reporting requirements reached 605 people, leading to more complete and accurate information being reported. XDRO data were also shared with local health departments.

Discussion/conclusions:

Mandatory reporting to the XDRO registry has provided important information on CRE epidemiology in Illinois, guiding regional CRE control efforts. Healthcare providers’ ability to access real-time CRE information may improve inter-facility communication and infection control practices. Automated alert functionality is being implemented to improve the efficiency of inter-facility communication.