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Transfer from High-Acuity Long-Term Care Facilities Is Associated with Carriage of Klebsiella pneumoniae Carbapenemase–Producing Enterobacteriaceae: A Multihospital Study

Published online by Cambridge University Press:  02 January 2015

Kavitha Prabaker ,
Michael Y. Lin ,
Margaret McNally ,
Kartikeya Cherabuddi ,
Sana Ahmed ,
Andrea Norris ,
Karen Lolans ,
Ruba Odeh ,
Vishnu Chundi  and
Robert A. Weinstein
...Show all authors
Kavitha Prabaker*
Affiliation:
Rush University Medical Center, Chicago, Illinois Cook County Health and Hospitals System, Chicago, Illinois
Michael Y. Lin
Affiliation:
Rush University Medical Center, Chicago, Illinois
Margaret McNally
Affiliation:
Our Lady of the Resurrection Medical Center, Chicago, Illinois
Kartikeya Cherabuddi
Affiliation:
Westlake Hospital, Melrose Park, Illinois, and University of Florida, Gainesville, Florida
Sana Ahmed
Affiliation:
Advocate Lutheran General Hospital, Park Ridge, Illinois
Andrea Norris
Affiliation:
Advocate Lutheran General Hospital, Park Ridge, Illinois
Karen Lolans
Affiliation:
Rush University Medical Center, Chicago, Illinois
Ruba Odeh
Affiliation:
Advocate Lutheran General Hospital, Park Ridge, Illinois
Vishnu Chundi
Affiliation:
Metro Infectious Disease Consultants, Chicago, Illinois
Robert A. Weinstein
Affiliation:
Rush University Medical Center, Chicago, Illinois Cook County Health and Hospitals System, Chicago, Illinois
Mary K. Hayden
Affiliation:
Rush University Medical Center, Chicago, Illinois
*
600 South Paulina Street, Suite 143, Chicago, IL 60612 ([email protected])
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Abstract

Objective.

To determine whether transfer from a long-term care facility (LTCF) is a risk factor for colonization with Klebsiella pneumoniae carbapenemase (KPC)–producing Enterobacteriaceae upon acute care hospital admission.

Design.

Microbiologic survey and nested case-control study.

Setting.

Four hospitals in a metropolitan area (Chicago) with an early KPC epidemic.

Patients.

Hospitalized adults.

Methods.

Patients transferred from LTCFs were matched 1 : 1 to patients admitted from the community by age (± 10 years), admitting clinical service, and admission date (± 2 weeks). Rectal swab specimens were collected within 3 days after admission and tested for KPC-producing Enterobacteriaceae. Demographic and clinical information was extracted from medical records.

Results.

One hundred eighty patients from LTCFs were matched to 180 community patients. KPC-producing Enterobacteriaceae colonization was detected in 15 (8.3%) of the LTCF patients and 0 (0%) of the community patients (P<.001). Prevalence of carriage differed by LTCF subtype: 2 of 135 (1.5%) patients from skilled nursing facilities without ventilator care (SNFs) were colonized upon admission, compared to 9 of 33 (27.3%) patients from skilled nursing facilities with ventilator care (VSNFs) and 4 of 12 (33.3%) patients from long-term acute care hospitals (LTACHs; P<.001). In a multivariable logistic regression model adjusted for a propensity score that predicted LTCF subtype, patients admitted from VSNFs or LTACHs had 7.0-fold greater odds of colonization (ie, odds ratio; 95% confidence interval, 1.3–42; P = .022) with KPC-producing Enterobacteriaceae than patients from an SNF.

Conclusions.

Patients admitted to acute care hospitals from high-acuity LTCFs (ie, VSNFs and LTACHs) were more likely to be colonized with KPC-producing Enterobacteriaceae than were patients admitted from the community. Identification of healthcare facilities with a high prevalence of colonized patients presents an opportunity for focused interventions that may aid regional control efforts.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 12 , December 2012 , pp. 1193 - 1199
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1.Queenan, AM, Bush, K. Carbapenemases; the versatile β-lactamases. Clin Microbiol Rev 2007;20(3):440–458.Google Scholar
2.Gasink, LB, Edelstein, PH, Lautenbach, E, Synnestvedt, M, Fishman, NO. Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase–producing K. pneumoniae. Infect Control Hosp Epidemiol 2009;30(12):1180–1185.Google Scholar
3.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
4.Schwaber, MJ, Klarfeld-Lidji, S, Navon-Venezia, S, Schwartz, D, Leavitt, A, Carmeli, Y. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52(3):1028–1033.10.1128/AAC.01020-07Google Scholar
5.Yigit, H, Queenan, AM, Anderson, GJ, et al.Novel carbapenem-hydrolyzing β-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother 2001;45(4):1151–1161.Google Scholar
6.Gupta, N, Limbago, BM, Patel, JB, Kallen, AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53(1):60–67.Google Scholar
7.Perez, F, Endimiani, A, Ray, AJ, et al.Carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae across a hospital system: impact of post-acute care facilities on dissemination. J Antimicrob Chemother 2010;65(8):1807–1818.10.1093/jac/dkq191Google Scholar
8.Marquez, P, Terashita, D, Dassey, D, Mascola, L, Los Angeles County Department of Public Health. Community-wide laboratory surveillance of carbapenem-resistant Klebsiella pneumoniae (CRKP): Los Angeles County 2010. Paper presented at: 21st Annual Meeting of the Society for Healthcare Epidemiology of America; April 1–4, 2011; Dallas, TX. Abstract 359.Google Scholar
9.Centers for Disease Control and Prevention (CDC). Carbapenem-resistant 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
10.Won, SY, Munoz-Price, LS, 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
11.Munoz-Price, LS. Long-term acute care hospitals. Clin Infect Dis 2009;49(3):438–443.10.1086/600391Google Scholar
12.Lin, MY, Lyles, RD, Lolans, K, et al.Prevalence of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) among adult patients in intensive care units (ICUs) and long-term acute care hospitals (LTACHs) in the Chicago region. Paper presented at: 49th Annual Meeting of the Infectious Diseases Society of America; October 20–23, 2011; Boston, MA. Abstract 396.Google Scholar
13.Lolans, K, Calvert, K, Won, S, Clark, J, Hayden, MK. Direct ertapenem disk screening method for identification of KPC-producing Klebsiella pneumoniae and Escherichia coli in surveillance swab specimens. J Clin Microbiol 2010;48(3):836–841.Google Scholar
14.Cole, JM, Schuetz, AN, Hill, CE, Nolte, FS. Development and evaluation of a real-time PCR assay for detection of Klebsiella pneumoniae carbapenemase genes. J Clin Microbiol 2009;47(2):322–326.Google Scholar
15. European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 1.3. http://www.eucast.org/clinical_breakpoints. Published 2011.Google Scholar
16.Matushek, MG, Bonten, MJ, Hayden, MK. Rapid preparation of bacterial DNA for pulsed-field gel electrophoresis. J Clin Microbiol 1996;34(10):2598–2600.Google Scholar
17.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33(9):2233–2239.Google Scholar
18.Bergstrom, N, Braden, BJ, Laguzza, A, Holman, V. The Braden Scale for predicting pressure sore risk. Nurs Res 1987;36(4):205–210.10.1097/00006199-198707000-00002Google Scholar
19.Brookhart, MA, Schneeweiss, S, Rothman, KJ, Glynn, RJ, Avorn, J, Sturmer, T. Variable selection for propensity score models. Am J Epidemiol 2006;163(12):1149–1156.Google Scholar
20.Bradley, SF, Terpenning, MS, Ramsey, MA, et al.Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115(6):417–422.Google Scholar
21.Gould, CV, Rothenberg, R, Steinberg, JP. Antibiotic resistance in long-term acute care hospitals: the perfect storm. Infect Control Hosp Epidemiol 2006;27(9):920–925.10.1086/507280Google Scholar
22.Elizaga, ML, Weinstein, RA, Hayden, MK. Patients in long-term care facilities: a reservoir for vancomycin-resistant enterococci. Clin Infect Dis 2002;34(4):441–446.10.1086/338461Google Scholar
23.Wiener, J, Quinn, JP, Bradford, PA, et al.Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999;281(6):517–523.10.1001/jama.281.6.517Google Scholar
24.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):966–968.10.1086/590661Google Scholar
25.Kochar, S, Sheard, T, Sharma, R, et al.Success of an infection control program to reduce the spread of carbapenem-resistant Klebsiella pneumoniae. Infect Control Hosp Epidemiol 2009;30(5):447–452.10.1086/596734Google Scholar
26.Ben-David, D, Masarwa, S, Navon-Venezia, S, et al.Carbapenem-resistant Klebsiella pneumoniae in post-acute-care facilities in Israel. Infect Control Hosp Epidemiol 2011;32(9):845–853.10.1086/661279Google Scholar
27.Endimiani, A, Depasquale, JM, 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):1102–1110.10.1093/jac/dkp327Google Scholar
28.Munoz-Price, LS, Hayden, MK, Lolans, K, et al.Successful control of an outbreak of Klebsiella pneumoniae carbapenemase–producing K. pneumoniae at a long-term acute care hospital. Infect Control Hosp Epidemiol 2010;31(4):341–347.Google Scholar
29. Department of Health and Human Services, Centers for Medicare and Medicaid Services. State operations provider certification. CMS manual system publication 100–07. http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R51SOMA.pdf. Published June 20, 2009. Updated 2009. Accessed June 25, 2012.Google Scholar
30.Mody, L, Langa, KM, Saint, S, Bradley, SF. Preventing infections in nursing homes: a survey of infection control practices in southeast Michigan. Am J Infect Control 2005;33(8):489–492.10.1016/j.ajic.2005.01.011Google Scholar
31.Roup, BJ, Roche, JC, Pass, M. Infection control program disparities between acute and long-term care facilities in Maryland. Am J Infect Control 2006;34(3):122–127.10.1016/j.ajic.2005.12.010Google Scholar
32.Roup, BJ, Scaletta, JM. How Maryland increased infection prevention and control activity in long-term care facilities, 2003–2008. Am J Infect Control 2011;39(4):292–295.10.1016/j.ajic.2010.09.004Google Scholar
33.Nelson, SR, Hayden, MK, Vernon, MO, Won, S, Heiman, K, Weinstein, RA. Increasing burden of carbapenem-resistant Enterobacteriaceae (CRE) in the Chicago metropolitan area: results of two surveys of infection preventionists. Paper presented at: 48th Annual Meeting of the Infectious Diseases Society of America; October 21–24, 2010; Vancouver, Canada. Abstract 360.Google Scholar
34.Ostrowsky, BE, Trick, WE, Sohn, AH, et al.Control of vancomycin-resistant enterococcus in health care facilities in a region. N Engl J Med 2001;344(19):1427–1433.Google Scholar
35.Schwaber, MJ, Lev, B, Israeli, A, et al.Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011;52(7):848–855.Google Scholar
36.Vernon, MO, Hayden, MK, Trick, WE, et al.Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006;166(3):306–312.10.1001/archinte.166.3.306Google Scholar
37.Thurlow, CJ, Prabaker, K, Lin, MY, et al.Skin colonization with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) among long-term acute care hospital (LTACH) patients. Paper presented at: 49th Annual Meeting of the Infectious Diseases Society of America; October 20–23, 2011; Boston, MA. Abstract 1347.Google Scholar
38.Oostdijk, EA, de Smet, AM, Kesecioglu, J, Bonten, MJ, Dutch SOD-SDD Trialists Group. The role of intestinal colonization with gram-negative bacteria as a source for intensive care unit-acquired bacteremia. Crit Care Med 2011;39(5):961–966.10.1097/CCM.0b013e318208ee26Google Scholar
39.Saidel-Odes, L, Polachek, 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