Date of Conferral





Public Health


Cheryl B. Cullen


Carbapenem-resistant Enterobacteriaceae (CRE) health care acquired infections are a serious public health threat due to a high mortality rate, economic burden, and depletion of last resort CRE antimicrobials. CRE infections have emerged as community-associated type infections in the United States. For CRE to now have that type of potential is cause for immediate and extensive action. The prevalence of CRE infection cases that were reported as community-associated CRE and health care acquired CRE by examining specific clinical characteristics between 4 selected states that were reported to respective state health departments and the Centers for Disease Control were explored in this study. The theoretical framework most appropriate for this study was the One Health foundation. Two research questions were formulated to address the association of the CRE clinical characteristics (organism identification, specimen source, medical facility type, and laboratory detection method) and the health care acquired Carbapenemase gene mechanism between 4 selected states (Colorado, Illinois, West Virginia, and South Dakota). For this quantitative retrospective study, secondary data was used with the Goodman and Kruskal’s lambda analysis. For the 1st time a significant relationship for the clinical characteristics of organism identification and lab gene detection method between the 4 selected U.S. states were established in this study. No relationships were established for the other 3 characteristics but provided insight for future studies. The positive social implication from this study was being able to formulate CRE predictive knowledge that could contribute to the reduction of CRE cases and provide vision to possible reasons why CRE has emerged as community-associated in the United States.

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