The Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Colonization and Infection among Long-Term Acute Care Hospital Residents
Published Date:Oct 12 2015
Source:Infect Control Hosp Epidemiol. 37(1):55-60.
Pubmed Central ID:PMC4815918
Funding:FOA#CK11-001/CK/NCEZID CDC HHS/United States
K01 AI103028/AI/NIAID NIH HHS/United States
K01-AI103028/AI/NIAID NIH HHS/United States
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.
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 multivariable model was developed to identify risk factors for CRKP infection or colonization.
222 patients were identified with K. pneumoniae clinical cultures during the study period; 99 (45%) were case patients and 123 (55%) were control patients. On multivariable analysis, factors associated with a significant risk for CRKP colonization or infection were solid organ or stem cell transplantation (OR, 5.05; 95% CI, 1.23 – 20.8, P=0.03), mechanical ventilation (OR, 2.56; 95% CI, 1.24 – 5.28, P=0.01), fecal incontinence (OR, 5.78; 95% CI, 1.52 – 22.0, P=0.01), and exposure in the prior 30 days to meropenem (OR, 3.55; 95% CI, 1.04 – 12.1, P=0.04), vancomycin (OR, 2.94; 95% CI, 1.18 – 7.32, P=0.02), and metronidazole (OR, 4.22; 95% CI, 1.28 – 14.0, P=0.02).
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.
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