Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Kathleen Winter

Committee Member

Meredith Duncan

Committee Member

Florence Funk


Multidrug-resistant organisms (MDROs), particularly Carbapenem-Resistant Enterobacterales (CRE), pose a significant threat to public health due to their resistance to multiple antibiotics, including carbapenems. CRE infections, especially those producing carbapenemases (CP-CRE), are associated with high morbidity and mortality rates, making them a growing concern in healthcare settings. Despite the prevalence of CRE infections in the United States, limited data exist on the incidence and distribution of CP-CRE infections in specific regions, such as the Appalachian counties of Kentucky.

This study aimed to investigate the cumulative incidence and distribution of CP-CRE cases in Appalachian and non-Appalachian counties of Kentucky, as well as the association between social deprivation and CP-CRE incidence. Data from the Kentucky Department for Public Health on CP-CRE cases reported between 2013 and 2020 were analyzed. Demographic characteristics, hospitalization status, organism type, and facility type were assessed among CP-CRE cases.

A total of 471 CP-CRE cases were analyzed, with a higher proportion reported in non-Appalachian counties compared to Appalachian counties. Significant differences were observed in race and Social Deprivation Index (SDI) scores between Appalachian and non-Appalachian counties. White individuals comprised a higher percentage of CP-CRE cases in Appalachian counties, while SDI scores indicated greater deprivation in Appalachian counties. Furthermore, a positive correlation was found between SDI scores and CP-CRE incidence, suggesting a potential link between social deprivation and CP-CRE prevalence.

While this study provides valuable insights into the distribution and correlates of CP-CRE infections in Kentucky, several limitations exist, including reliance on passive surveillance and a limited surveillance period. Future research should focus on enhancing MDRO surveillance efforts, particularly in underserved regions like the Appalachian counties of Kentucky, to better understand and mitigate the spread of CP-CRE infections.

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