Abstract Objective: Multidrug-resistant organisms (MDROs) such as carbapenem-resistant Enterobacterales (CRE) are a significant public health threat. Patients colonized with MDROs are at higher risk of severe outcomes and can serve as a source of spread to others. The public health impact of a hypothetical agent that reduces MDRO load (i.e., pathogen reduction), including in the gastrointestinal tract, has not been described. Design: Compartmental models of CRE transmission in healthcare facilities were used to estimate the impact of a hypothetical pathogen reduction agent on CRE bloodstream infections (BSIs) and deaths. Methods: The agent was assumed to reduce the time to pathogen clearance with effectiveness varying from 25–100% across simulations. Interventions were modeled in acute care hospitals (ACHs), critical access hospitals, long-term acute care hospitals (LTACHs), skilled nursing facilities, and ventilator-capable skilled nursing facilities (vSNFs). Direct effects (among patients who received the agent) and indirect effects (among patients who did not receive the agent) were estimated at the national healthcare network level. Results: At baseline without intervention, an estimated 2,086 CRE BSIs and 622 associated deaths occurred annually nationwide. Use of a pathogen reduction agent in LTACHs and vSNFs averted 69–75% of CRE BSIs nationally, with greater reductions when expanded to all facility types. Approximately 90% of averted CRE BSIs would have occurred in patients who were not administered the agent. Conclusions: An effective pathogen reduction agent might substantially reduce MDRO infections and deaths among patients in U.S. healthcare facilities. New and expanded efforts are needed to accelerate the development of such products.
Wolford et al. (2026) studied this question.