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The Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Colonization and Infection among Long-Term Acute Care Hospital Residents

Published online by Cambridge University Press:  12 October 2015

John P Mills ,
Naasha J Talati ,
Kevin Alby  and
Jennifer H Han
John P Mills
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Naasha J Talati
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Good Shepherd Penn Partners, University of Pennsylvania Health System, Philadelphia, Pennsylvania
Kevin Alby
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Jennifer H Han*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
*
Address correspondence to Jennifer Han, MD, MSCE, Division of Infectious Diseases, Department of Medicine, 811 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 ([email protected]).
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Abstract

OBJECTIVE

An improved understanding of carbapenem-resistant Klebsiella pneumoniae (CRKP) in long-term acute care hospitals (LTACHs) is needed. The objective of this study was to assess risk factors for colonization or infection with CRKP in LTACH residents.

METHODS

A case-control study was performed at a university-affiliated LTACH from 2008 to 2013. Cases were defined as all patients with clinical cultures positive for CRKP and controls were those with clinical cultures positive for carbapenem-susceptible K. pneumoniae (CSKP). A multivariate model was developed to identify risk factors for CRKP infection or colonization.

RESULTS

A total of 222 patients were identified with K. pneumoniae clinical cultures during the study period; 99 (45%) were case patients and 123 (55%) were control patients. Our multivariate analysis identified factors associated with a significant risk for CRKP colonization or infection: solid organ or stem cell transplantation (OR, 5.05; 95% CI, 1.23–20.8; P=.03), mechanical ventilation (OR, 2.56; 95% CI, 1.24–5.28; P=.01), fecal incontinence (OR, 5.78; 95% CI, 1.52–22.0; P=.01), and exposure in the prior 30 days to meropenem (OR, 3.55; 95% CI, 1.04–12.1; P=.04), vancomycin (OR, 2.94; 95% CI, 1.18–7.32; P=.02), and metronidazole (OR, 4.22; 95% CI, 1.28–14.0; P=.02).

CONCLUSIONS

Rates of colonization and infection with CRKP were high in the LTACH setting, with nearly half of K. pneumoniae cultures demonstrating carbapenem resistance. Further studies are needed on interventions to limit the emergence of CRKP in LTACHs, including targeted surveillance screening of high-risk patients and effective antibiotic stewardship measures.

Infect. Control Hosp. Epidemiol. 2015;37(1):55–60

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 1 , January 2016 , pp. 55 - 60
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. The results of this study were previously presented as an Oral Abstract Presentation at the Society for Healthcare Epidemiology of America (SHEA) Spring 2015 Conference in Orlando, Florida, on May 16, 2015.

References

REFERENCES

1. Bogan, C, Kaye, KS, Chopra, T, et al. Outcomes of carbapenem-resistant Enterobacteriaceae isolation: matched analysis. Am J Infect Control 2014;42:612–620.CrossRefGoogle ScholarPubMed
2. Borer, A, Saidel-Odes, L, Riesenberg, K, et al. Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia. Infect Control Hosp Epidemiol 2009;30:972–976.CrossRefGoogle ScholarPubMed
3. Falagas, ME, Tansarli, GS, Karageorgopoulos, DE, Vardakas, KZ. Deaths attributable to carbapenem-resistant Enterobacteriaceae infections. Emerg Infect Dis 2014;20:1170–1175.Google Scholar
4. Snitkin, ES, Zelazny, AM, Thomas, PJ, et al. Tracking a hospital outbreak of carbapenem-resistant Klebsiella pneumoniae with whole-genome sequencing. Sci Transl Med 2012;4:148ra116.Google Scholar
5. Tzouvelekis, LS, Markogiannakis, A, Psichogiou, M, Tassios, PT, Daikos, GL. Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions. Clin Microbiol Rev 2012;25:682–707.Google Scholar
6. Gasink, LB, Edelstein, PH, Lautenbach, E, Synnestvedt, M, Fishman, NO. Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae . Infect Control Hosp Epidemiol 2009;30:1180–1185.Google Scholar
7. Yigit, H, Queenan, AM, Anderson, GJ, et al. Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae . Antimicrob Agents Chemother 2001;45:1151–1161.Google Scholar
8. Lin, MY, Lyles-Banks, RD, Lolans, K, et al. The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2013;57:1246–1252.Google Scholar
9. Won, SY, Munoz-Price, LS, Lolans, K, Hota, B, Weinstein, RA, Hayden, MK. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2011;53:532–540.CrossRefGoogle ScholarPubMed
10. Marchaim, D, Chopra, T, Bogan, C, et al. The burden of multidrug-resistant organisms on tertiary hospitals posed by patients with recent stays in long-term acute care facilities. Am J Infect Control 2012;40:760–765.Google Scholar
11. Marquez, P, Terashita, D, Dassey, D, Mascola, L. Population-based incidence of carbapenem-resistant Klebsiella pneumoniae along the continuum of care, Los Angeles County. Infect Control Hosp Epidemiol 2013;34:144–150.CrossRefGoogle ScholarPubMed
12. Munoz-Price, LS. Long-term acute care hospitals. Clin Infect Dis 2009;49:438–443.Google Scholar
13. Chitnis, AS, Caruthers, PS, Rao, AK, et al. Outbreak of carbapenem-resistant enterobacteriaceae at a long-term acute care hospital: sustained reductions in transmission through active surveillance and targeted interventions. Infect Control Hosp Epidemiol 2012;33:984–992.CrossRefGoogle Scholar
14. Endimiani, A, Depasquale, JM, Forero, S, et al. Emergence of blaKPC-containing Klebsiella pneumoniae in a long-term acute care hospital: a new challenge to our healthcare system. J Antimicrob Chemother 2009;64:1102–1110.CrossRefGoogle Scholar
15. Gould, CV, Rothenberg, R, Steinberg, JP. Antibiotic resistance in long-term acute care hospitals: the perfect storm. Infect Control Hosp Epidemiol 2006;27:920–925.Google Scholar
16. Performance Standards for Antimicrobial Susceptibility Testing; Twentieth Information Supplement. Clinical and Laboratory Standards Institute June 2010;M100-S20-U Vol. 30.Google Scholar
17. Mickey, RM, Greenland, S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol 1989;129:125–137.Google Scholar
18. Vital signs: carbapenem-resistant Enterobacteriaceae. MMWR Morb Mortal Wkly Rep 2013;62:165–170.Google Scholar
19. Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE): 2012 CRE Toolkit. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf. Accessed July 1, 2015.Google Scholar
20. Patel, G, Huprikar, S, Factor, SH, Jenkins, SG, Calfee, DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008;29:1099–1106.Google Scholar
21. Mathers, AJ, Cox, HL, Bonatti, H, et al. Fatal cross infection by carbapenem-resistant Klebsiella in two liver transplant recipients. Transpl Infect Dis 2009;11:257–265.Google Scholar
22. Leavitt, A, Navon-Venezia, S, Chmelnitsky, I, Schwaber, MJ, Carmeli, Y. Emergence of KPC-2 and KPC-3 in carbapenem-resistant Klebsiella pneumoniae strains in an Israeli hospital. Antimicrob Agents Chemother 2007;51:3026–3029.CrossRefGoogle Scholar
23. Thurlow, CJ, Prabaker, K, Lin, MY, Lolans, K, Weinstein, RA, Hayden, MK. Anatomic sites of patient colonization and environmental contamination with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae at long-term acute care hospitals. Infect Control Hosp Epidemiol 2013;34:56–61.Google Scholar
24. Kotsanas, D, Wijesooriya, WR, Korman, TM, et al. “Down the drain”: carbapenem-resistant bacteria in intensive care unit patients and handwashing sinks. Med J Aust 2013;198:267–269.Google Scholar
25. Hussein, K, Sprecher, H, Mashiach, T, Oren, I, Kassis, I, Finkelstein, R. Carbapenem resistance among Klebsiella pneumoniae isolates: risk factors, molecular characteristics, and susceptibility patterns. Infect Control Hosp Epidemiol 2009;30:666–671.Google Scholar