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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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