The importance of long-term acute care hospitals in the regional epidemiology of klebsiella pneumoniae carbapenemase-producing enterobacteriaceae

Michael Y. Lin*, Rosie D. Lyles-Banks, Karen Lolans, David W. Hines, Joel B. Spear, Russell Petrak, William E. Trick, Robert A. Weinstein, Mary K. Hayden, Alexander J. Kallen, Ninfa Acuna, Rosemary Albright, Pat Alexander, Therese Anthony, Laura Bardowski, Cate Berends, Amanda Bonebrake, Judy Bova, Annie Braggs, Stephanie BurtunMary Alice Byrnes, Carol Cagle, Rose Chavis, Sue Cienkus, Sheila Collins-Johnson, Cari Coomer, Theresa Chou, Diane Cullen, Delia Deguzman, Onofre Donceras, Margaret Feller, Sharon Fung, Jo Anne Marie Gasienica, Silvia Garcia-Houchins, Gerry Genovese, Marge Gentile, Gregg Gonzaga, Edward Goodwin, Elsie Hernandez, James Kerridge, Jean Kirk, Mary Alice Lavin, Susan Lee, Jan Lepinski, Sandra Myrick, Toni Oats, Anna O'Donnell, Violetta Pasinos, Jo Ann Patton, Maria Perez, Joanne Purpura, Linda Rakoski, Sandra Reiner, Asif Saiyed, Mary Santine, Barbara Schmitt, Carol Schultz, Rose Marie Semar, Helen Sethuraman, Chris Silkaitis, Elizabeth Stutler, Annie Thompson, Katie Wickman, Maureen Bolon, Andrew Cha, Emily Landon, James Malow, Sunita Mohapatra, John Segreti, Stephen Weber, Sharon Welbel, Teresa Zembower

*Corresponding author for this work

Research output: Contribution to journalArticle

125 Scopus citations

Abstract

Background. In the United States, Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae are increasingly detected in clinical infections; however, the colonization burden of these organisms among short-stay and long-term acute care hospitals is unknown.Methods. Short-stay acute care hospitals with adult intensive care units (ICUs) in the city of Chicago were recruited for 2 cross-sectional single-day point prevalence surveys (survey 1, July 2010-January 2011; survey 2, January-July 2011). In addition, all long-term acute care hospitals (LTACHs) in the Chicago region (Cook County) were recruited for a single-day point prevalence survey during January-May 2011. Swab specimens were collected from rectal, inguinal, or urine sites and tested for Enterobacteriaceae carrying blaKPC.Results. We surveyed 24 of 25 eligible short-stay acute care hospitals and 7 of 7 eligible LTACHs. Among LTACHs, 30.4% (119 of 391) of patients were colonized with KPC-producing Enterobacteriaceae, compared to 3.3% (30 of 910) of short-stay hospital ICU patients (prevalence ratio, 9.2; 95% confidence interval, 6.3-13.5). All surveyed LTACHs had patients harboring KPC (prevalence range, 10%-54%), versus 15 of 24 short-stay hospitals (prevalence range, 0%-29%). Several patient-level covariates present at the time of survey - LTACH facility type, mechanical ventilation, and length of stay - were independent risk factors for KPC-producing Enterobacteriaceae colonization.Conclusions. We identified high colonization prevalence of KPC-producing Enterobacteriaceae among patients in LTACHs. Patients with chronic medical care needs in long-term care facilities may play an important role in the spread of these extremely drug-resistant pathogens.

Original languageEnglish (US)
Pages (from-to)1246-1252
Number of pages7
JournalClinical Infectious Diseases
Volume57
Issue number9
DOIs
StatePublished - Nov 1 2013

Keywords

  • Klebsiella pneumoniae carbapenemase
  • carbapenem-resistant Enterobacteriaceae
  • healthcare epidemiology
  • intensive care units
  • long-term care facilities

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Lin, M. Y., Lyles-Banks, R. D., Lolans, K., Hines, D. W., Spear, J. B., Petrak, R., Trick, W. E., Weinstein, R. A., Hayden, M. K., Kallen, A. J., Acuna, N., Albright, R., Alexander, P., Anthony, T., Bardowski, L., Berends, C., Bonebrake, A., Bova, J., Braggs, A., ... Zembower, T. (2013). The importance of long-term acute care hospitals in the regional epidemiology of klebsiella pneumoniae carbapenemase-producing enterobacteriaceae. Clinical Infectious Diseases, 57(9), 1246-1252. https://doi.org/10.1093/cid/cit500