Modifiable Risk Factors for the Spread of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae Among Long-Term Acute-Care Hospital Patients

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Okamoto, Koh ; Lin, Michael Y. ; Haverkate, Manon ; Lolans, Karen ; Moore, Nicholas M. ; Weiner, Shayna ; Lyles, Rosie D. ; Blom, Donald ; Rhee, Yoona ; Kemble, Sarah ; Fogg, Louis ; Hines, David W. ; Weinstein, Robert A. ; Hayden, Mary K.
• Corporate Authors:
  CDC Prevention Epicenters Program
• Description:
  Objective.
  
  To identify modifiable risk factors for acquisition of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) colonization among long-term acute-care hospital (LTACH) patients.
  
  Design.
  
  Multicenter, matched case-control study.
  
  Setting.
  
  Four LTACHs in Chicago, Illinois.
  
  Participants.
  
  Each case patient included in this study had a KPC-negative rectal surveillance culture on admission followed by a KPC-positive surveillance culture later in the hospital stay. Each matched control patient had a KPC-negative rectal surveillance culture on admission and no KPC isolated during the hospital stay.
  
  Results.
  
  From June 2012 to June 2013, 2,575 patients were admitted to 4 LTACHs; 217 of 2,144 KPC-negative patients (10.1%) acquired KPC. In total, 100 of these patients were selected at random and matched to 100 controls by LTACH facility, admission date, and censored length of stay. Acquisitions occurred a median of 16.5 days after admission. On multivariate analysis, we found that exposure to higher colonization pressure (OR, 1.02; 95% CI, 1.01–1.04; P = .002), exposure to a carbapenem (OR, 2.25; 95% CI, 1.06–4.77; P = .04), and higher Charlson comorbidity index (OR, 1.14; 95% CI, 1.01–1.29; P = .04) were independent risk factors for KPC acquisition; the odds of KPC acquisition increased by 2% for each 1% increase in colonization pressure.
  
  Conclusions.
  
  Higher colonization pressure, exposure to carbapenems, and a higher Charlson comorbidity index independently increased the odds of KPC acquisition among LTACH patients. Reducing colonization pressure (through separation of KPC-positive patients from KPC-negative patients using strict cohorts or private rooms) and reducing carbapenem exposure may prevent KPC cross transmission in this high-risk patient population.
  
  
• Subjects:
  Aged Bacterial Proteins Beta-Lactamases Carbapenems Case-Control Studies Comorbidity Cross Infection Female Hospitals Humans Klebsiella Infections Klebsiella Pneumoniae Long-Term Care Male Middle Aged Population Surveillance Rectum Risk Factors

  More +
• Source:
  Infect Control Hosp Epidemiol. 38(6):670-677
• Pubmed ID:
  28397615
• Pubmed Central ID:
  PMC8381232
• Document Type:
  Journal Article
• Funding:
  U54 CK000161/CK/NCEZID CDC HHSUnited States/ ; U54 CK000481/CK/NCEZID CDC HHSUnited States/
• Volume:
  38
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:1de88779db6901b404b04e42514c4093044c09365a7d54105a413e3109a5932a
• Download URL:
  https://stacks.cdc.gov/view/cdc/109153/cdc_109153_DS1.pdf
• File Type:
  [PDF - 511.50 KB ]