Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-23T09:27:00.006Z Has data issue: false hasContentIssue false
  • English
  • Français

Population-Based Incidence of Carbapenem-Resistant Klebsiella pneumoniae along the Continuum of Care, Los Angeles County

Published online by Cambridge University Press:  02 January 2015

Patricia Marquez ,
Dawn Terashita ,
David Dassey  and
Laurene Mascola
Patricia Marquez*
Affiliation:
Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California
Dawn Terashita
Affiliation:
Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California
David Dassey
Affiliation:
Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California
Laurene Mascola
Affiliation:
Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California
*
313 North Figueroa Street, Room 212, Los Angeles, CA 90012 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging multidrug-resistant pathogen associated with higher mortality, longer hospital stays, and increased costs. CRKP was thought to be sporadic in Los Angeles County (LAC); however, the actual incidence is unknown. To address this, LAC declared CRKP a laboratory-reportable disease on June 1, 2010.

Design.

Laboratory-based community-wide surveillance.

Patients.

Any individual who was identified as CRKP positive. CRKP was defined as a K. pneumoniae isolate resistant to all carbapenems by 2010 Clinical and Laboratory Standards Institute criteria.

Methods.

Laboratory directors of 102 LAC acute care hospitals (ACHs) and 5 reference laboratories were to submit susceptibility testing results for all CRKP-positive specimens. Positive specimens from the same patient within the same calendar month of previous culture were excluded.

Results.

A total of 814 reports were received from June 1, 2010, through May 31, 2011, from 69 laboratories; 675 (83%) met the case definition. Cases were reported from ACHs (387 [57%]), long-term ACHs (LTACs; 231 [34%]), and skilled nursing facilities (57 [8%]); an outbreak in 1 LTAC was identified. The pooled mean incidence rate in LAC ACHs and LTACs was 0.46 per 1,000 patient-days; the rate in LTACs (2.54 per 1,000 patient-days) was higher than that in ACHs (0.31 per 1,000 patient-days; P < .001). Sixty-five individuals had multiple incidences, accounting for 147 case reports.

Conclusion.

CRKP is more present in LAC than suspected. Rates were consistently higher in LTACs than in ACHs. Heightened awareness of this problem is needed in all LAC healthcare facilities, as patients access services along the continuum of care.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 2 , February 2013 , pp. 144 - 150
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Ben-David, D, Kordevani, R, Keller, N, et al. Outcome of car-bapenem resistant Klebsiella pneumoniae bloodstream infections. Clin Microbiol Infect 2011;18(1):54–60.Google Scholar
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(10):972–976.Google Scholar
3. Schwaber, M, Carmeli, Y. Carbapenem-resistant Enterobacteriaceae: a potential threat. JAMA 2008;300(24):2911–2913.Google Scholar
4. Schwaber, M, Klarfeld-Lidji, S, Navon-Venezia, S, et al. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52(3):1028–1033.Google Scholar
5. Yan, J, Ko, W, Tsai, S, et al. Outbreak of infection with multidrug-resistant Klebsiella pneumoniae carrying blaIMP.8 in a university medical center in Taiwan. J Clin Microbiol 2001;39(12):4433–4439.Google Scholar
6. Quale, J, Landman, D, Bradford, P, et al. Molecular epidemiology of a citywide outbreak of extended-spectrum β-lactamase-producing Klebsiella pneumoniae infection. Clin Infect Dis 2002; 35(7):834–841.Google Scholar
7. Gupta, N, Limbago, B, Patel, J, et al. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53(1):60–67.Google Scholar
8. Bratu, S, Landman, D, Haag, R, et al. Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City. Arch Intern Med 2005;165(12):1430–1435.Google Scholar
9. Won, S, Munoz-Price, L, Lolans, K, et al. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2011;53(6): 532–540.Google Scholar
10. Gregory, CJ, Llata, E, Stine, N, et al. Outbreak of carbapenem-resistant Klebsiella pneumoniae in Puerto Rico associated with a novel carbapenemase variant. Infect Control Hosp Epidemiol 2010;31(5):476–484.Google Scholar
11. Centers for Disease Control and Prevention. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR Morb Mortal Wkly Rep 2009;58(10):256–260.Google Scholar
12. Weiner-Well, Y, Rudensky, B, Yinnon, A, et al. Carriage rate of carbapenem-resistant Klebsiella pneumoniae in hospitalised patients during a national outbreak. J Hosp Infect 2010;74(4): 344–349.Google Scholar
13. Bratu, S, Mooty, M, Nichani, S, et al. Emergence of KPC-pos-sessing Klebsiella pneumoniae in Brooklyn, New York: epidemiology and recommendations for detection. Antimicrob Agents Chemother 2005;49(7):3018–3020.Google Scholar
14. Srinivasan, A, Patel, JB. Klebsiella pneumoniae carbapenemase-producing organisms: an ounce of prevention really is worth a pound of cure. Infect Control Hosp Epidemiol 2008;29(12): 1107–1109.Google Scholar
15. Nordmann, P, Cuzon, G, Naas, T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis 2009;9(4):228–236.Google Scholar
16. Mathers, AJ, Cox, HL, Kitchel, B, et al. Molecular dissection of an outbreak of carbapenem-resistant Enterobacteriaceae reveals intergenus KPC carbapenemase transmission through a promiscuous plasmid. mBio 2011;2(6):e00204-11.Google Scholar
17. Samra, Z, Ofir, O, Lishtzinsky, Y, et al. Outbreak of carbapenem-resistant Klebsiella pneumoniae producing KPC-3 in a tertiary medical centre in Israel. Int J Antimicrob Agents 2007;30(6): 525–529.Google Scholar
18. Ikonomidis, A, Tokatlidou, D, Kristo, I, et al. Outbreaks in distinct regions due to a single Klebsiella pneumoniae clone carrying a blaVIM-1 metallo-β-lactamase gene. J Clin Microbiol 2005;43(10): 5344–5347.Google Scholar
19. Navon-Venezia, S, Leavitt, A, Schwaber, M, et al. First report on a hyperepidemic clone of KPC-3-producing Klebsiella pneumoniae in Israel genetically related to a strain causing outbreaks in the United States. Antimicrob Agents Chemother 2009;53(2):818–820.Google Scholar
20. Elemam, A, Rahimian, J, Mandeli, W. Infection with panresistant Klebsiella pneumoniae: a report of 2 cases and a brief review of the literature. Clin Infect Dis 2009;49(2):271–274.Google Scholar
21. Hussein, K, Sprecher, H, Maschiach, 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(7):666–671.Google Scholar
22. Gasink, LB, Edelstein, PH, Lautenbach, E, Synnestvedt, M, Fish-man, NO. Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae . Infect Control Hosp Epidemiol 2009;30(12):1180–1185.Google Scholar
23. Patel, G, Huprikar, S, Factor, S, 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(12):1099–1106.Google Scholar
24. Falgas, M, Rafailidis, P, Kofteridis, D, et al. Risk factors of carbapenem-resistant Klebsiella pneumoniae infections: a matched case-control study. J Antimicrob Chemother 2007;60(5):1124–1130.Google Scholar
25. Woodford, N, Tierno, P, Young, K, et al. Outbreak of Klebsiella pneumoniae producing a new carbapenem-hydrolyzing class A β-lactamase, KPC-3, in a New York medical center. Antimicrob Agents Chemother 2004;48(12):4793–4799.Google Scholar
26. Weisenberg, S, Morgan, D, Espinal-Witter, R, et al. Clinical outcomes of patients with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae after treatment with imipenem or meropenem. Diagn Mircrobiol Infect Dis 2009;64(2):233–235.Google Scholar
27. Ben-David, D, Maor, Y, Keller, N, et al. Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection. Infect Control Hosp Epidemiol 2010;31(6):620–626.Google Scholar
28. Calfee, D, Jenkins, SG. Use of active surveillance cultures to detect asymptomatic colonization with carbapenem-resistant Klebsiella pneumoniae in intensive care unit patients. Infect Control Hosp Epidemiol 2008;29(10):966–968.Google Scholar
29. Schechner, V, Kotlovsky, T, Tarabeia, J, et al. Predictors of rectal carriage of carbapenem-resistant Enterobacteriaceae (CRE) among patients with known CRE carriage at their next hospital encounter. Infect Control Hosp Epidemiol 2011;32(5):497–503.Google Scholar
30. Clinical and Laboratory Standards Institute (CLSI). M100-S20 Enterobacteriaceae Susceptibility—Cephalosporin and Carba-penem Breakpoint Revisions. Wayne, PA: CLSI, 2010.Google Scholar
31. Duffy, J, Sievert, D, Rebman, C, et al. Effective state-based surveillance for multidrug-resistant organisms related to health care-associated infections. Public Health Rep 2011;126(2):176–185.Google Scholar
32. Saidel-Odes, L, Polacheck, H, Peled, N, et al. A randomized, double-blind, placebo-controlled trial of selective digestive decontamination using oral gentamicin and oral polymyxin E for eradication of carbapenem-resistant Klebsiella pneumoniae carriage. Infect Control Hosp Epidemiol 2012;33(1):14–19.Google Scholar
33. Bonomo, R. Multiple antibiotic-resistant bacteria in long-term-care facilities: an emerging problem in the practice of infectious diseases. Clin Infect Dis 2000;31(6):1414–1422.Google Scholar
34. Centers for Disease Control and Prevention. Carbapenemresistant Klebsiella pneumoniae associated with a long-term-care facility—West Virginia, 2009-2011. MMWR Morb Mortal Wkly Rep 2011;60(41):1418–1420.Google Scholar
35. Endimiani, A, DePasquale, J, Forero, S, et al. Emergence of bla KPC-containing Klebsiella pneumoniae in a long-term acute care hospital: a new challenge to our healthcare system. J Antimicrob Chemother 2009;64(5):1102–1110.Google Scholar
36. Tenover, F, Kalsi, R, Williams, P, et al. Carbapenem resistance in Klebsiella pneumoniae not detected by automated susceptibility testing. Emerg Infect Dis 2006;12(8):1209–1213.Google Scholar
37. Anderson, K, Lonsway, D, Rasheed, J, et al. Evaluation of methods to identify the Klebsiella pneumoniae carbapenemase in Enterobacteriaceae. J Clin Microbiol 2007;45(8):2723–2725.Google Scholar
38. Tan, T, Ng, L. Comparison of three standardized disc susceptibility testing methods for Colistin. J Antimicrob Chemother 2006; 58(4):864–867.Google Scholar
39. Centers for Disease Control and Prevention (CDC). Inter-Facility Infection Control Transfer Form for States Establishing HAI Prevention Collaboratives Using ARRA Funds. Atlanta: CDC, 2010. http://www.cdc.gov/HAI/toolkits/InterfacilityTransferCommunicationFormll-2010.pdf. Accessed August 24, 2012.Google Scholar