Creating Automatic Alerts for Patients with XDROs

Throughout this week, thousands will gather in Washington DC to attend and participate in IDWeek 2019. The conference is the annual meeting of the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), the HIV Medical Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS).

From epidemiology and infection control to transplant infectious diseases and HIV/AIDS, IDWeek is the hub for all things infectious disease. Of the hundreds of presentations, 1 that particularly caught my attention was about how automatic alerting efforts were implemented for extensively drug-resistant organisms (XDROs).

Perhaps one of the increasingly more apparent challenges of battling antimicrobial resistance is that of surveillance. This presentation by Michael Y. Lin, MD, MPH, of Rush University Medical Center, discussed the Illinois XDRO Registry.

Created in 2013, this data source for XDROs focuses on carbapenem-resistant Enterobacteriaceae (CRE), carbapenemase-producing Pseudomonas aeruginosa, and Candida auris. The registry essentially allows health care facilities to access data to identify if patients being admitted have a history of colonization or infection with the aforementioned organisms.

Data is submitted through hospitals and allows for alerts to be created, automatically, which are sent via email, page, or even a text to the hospital’s infection preventionist when the patient is admitted.

“Facilities achieved automated alerts by sending a near-real-time feed of inpatient admission data (patient name and date of birth) to Illinois Department of Public Health (IDPH) via 1 of 3 connection types: direct (data sent directly to IDPH), vendor (data sent via vendor software), and syndromic surveillance (existing syndromic surveillance data adapted for registry).”

In an assessment of the registry, the team evaluated report submissions and total queries (manual and automated) by organism. They found 6445 unique patients within the registry, and more than 11,258 reports across 213 facilities. Of those facilities, 75 had worked to implement and maintain automatic alerting. Data connections were mostly direct or by vendor.

When the investigators evaluated the total number of automatic alerts, they found that 5344 had occurred for 1555 patients. Over time, there was a statistically significant increase in automatic alerts. When assessed, the investigators found that infection preventionists reported feedback on over 3000 CRE alerts and of 1176 first alerts/patient/facility, 49% of those patients with a XDRO had an unknown status in the hospital, meaning that had the alert not been utilized, the health care providers and infection prevention team would not have known about the XDRO colonization/infection. Of those patients who were unknown to the facilities, 33% were not in contact precautions when the alert occurred, indicating that it is highly beneficial for reducing disease transmission.

The XDRO Registry was initially created to focus on CRE but its expansion has shown considerable application as other highly concerning and resistant infections spread, like Candida auris. In many ways, this registry acts as a notification for emerging infectious diseases and can provide health care facilities with the rapid identification that is needed to isolate patients and prevent transmission. The presenter emphasized that the ability for the registry to be modified, especially in reporting structure and automatic alerts, has allowed for increased application and efficacy. This registry and its application for health care facilities is highly encouraging and sheds light on ways we can reduce the transmission of not only MDROs but also XRDOs.

The abstract, First Five Years of Experience with the Illinois Extensively Drug Resistant Organism (XDRO) Registry and Implementation of Automated Alerting, was presented in an oral abstract session on Thursday, October 3, 2019, at IDWeek 2019 in Washington, DC.