Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Among Patients Without Usual Risk Factors—Kentucky, 2016
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Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Among Patients Without Usual Risk Factors—Kentucky, 2016

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  • Alternative Title:
    Open Forum Infect Dis
  • Description:

    On August 11, 2016, Hospital A notified Kentucky Department for Public Health of 2 carbapenemase-producing (CP) carbapenem-resistant Enterobacteriaceae (CRE) identified from clinical cultures from patients without CRE risk factors, including limited prior health care exposure and short hospitalizations. This hospital had no previously reported CRE infections. We investigated to identify and provide recommendations on patient exposures, additional cases, and environmental reservoirs.


    A case was defined as any CRE culture collected at Hospital A January 1–December 12, 2016. Case finding was conducted by using laboratory records and screening cultures of patients. Patient exposures were identified through medical chart abstraction, patient interviews, and environmental sampling.


    In addition to 2 initial cases, 21 additional cases were identified. Three Enterobacteriaceae genera (Klebsiella pneumoniae [17], Escherichia coli [5], and Enterobacter cloacae [1]) and 2 carbapenemases were identified. Sixteen of 21 admitted patients (76%) were CRE positive <7 days after admission; 11 (69%) were pulsed-field gel electrophoresis matched to another CRE, had prior negative screening culture, or no health care exposure during the past year. Thirteen patients were interviewed; 5 (38%) had traveled regionally outside Kentucky or to large Kentucky cities for health care. Environmental sampling identified evidence of carbapenemase on an environmental services (EVS) cart and in an EVS drain.


    The CP-CRE outbreak was likely attributable to both importation and rapid in-facility transmission. Carbapenemase presence on EVS equipment indicates a role in health care CRE transmission. Additionally, regional travel for health care was identified as a potential CRE exposure in low-prevalence areas. Recommendations included routine disinfection of EVS equipment and addition of regional travel for health care to the facility’s patients at high-risk surveillance questionnaire.


    All authors: No reported disclosures.

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