2481. Comparing inter-hospital patient movement patterns to better understand mechanisms for regional dissemination of carbapenem-resistant Enterobacteriaceae

Abstract

Background

Understanding inter-hospital movement of patients provides insight into regional transmission of multidrug-resistant organisms (MDROs) that can guide containment efforts. Movement of general patient populations are often used for this purpose, but movement of the specific patient population of MDRO carriers may be more useful. We sought to compare movement of CRE patients with that of other patient populations to explore whether CRE carriers move differently, and if so, to determine whether administrative data can be used to identify patient populations with transfer patterns that mimic CRE patients.

Methods

We used New York’s Statewide Planning and Research Cooperative System (SPARCS), to create a patient network of all acute care hospital encounters (“overall hospital population”) during 2013–2015. We identified the subset of CRE cases in the network by linking the SPARCS data to CRE cases reported to the National Healthcare Safety Network in 2014, matching on admission date, date of birth, gender, and facility. We described patient characteristics and movement patterns across 3 cohorts: (1) CRE cases, (2) overall hospital population, (3) CRE surrogate (patients clinically similar to CRE cases based on length of stay [LOS] ≥14 days and Clinical Classification Software [CCS] category of sepsis plus at least one of the following additional CCS categories: adult respiratory failure, acute renal failure, procedure complication or device complication). Correlations between cohorts were calculated using patient transfer matrices to determine similarities between the networks.

Results

The average LOS for CRE cases was 25× higher than the overall hospital population (31.4 vs. 1.3 days, Figure 1a), and CRE cases were more likely to die or be discharged to a skilled nursing facility (Figure 1b). CRE movement networks were only moderately correlated with the overall hospital population (R² = 0.51); there was higher correlation between CRE case and CRE surrogate networks (R² = 0.73).

Conclusion

CRE patients have different healthcare experiences in the hospital and between hospitals in New York compared with the overall hospital population. The CRE surrogate cohort transfer patterns were more similar, and could be used to understand CRE patient movement in the absence of CRE culture data.

Disclosures

All authors: No reported disclosures.