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Clin Infect Dis. The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae
[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]
The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae
Michael Y. Lin 1, Rosie D. Lyles-Banks 2, Karen Lolans 3, David W. Hines 4, Joel B. Spear 5, Russell Petrak 4, William E. Trick 1,2, Robert A. Weinstein 1,2, Mary K. Hayden 1,3, for the CDC Prevention Epicenters Program (R.A.W.?PI)
Author Affiliations: <SUP>1</SUP>Department of Medicine, Rush University Medical Center, Chicago, U.S.A <SUP>2</SUP>Department of Medicine, Cook County Health and Hospitals System, Chicago, U.S.A <SUP>3</SUP>Department of Pathology, Rush University Medical Center, Chicago, U.S.A <SUP>4</SUP>Metro Infectious Diseases Consultants, LLC, Burr Ridge, U.S.A <SUP>5</SUP>Department of Medicine, St. Joseph Hospital, Chicago, U.S.A
Corresponding author: Michael Y. Lin, M.D., M.P.H., 600 S. Paulina St., Ste 143, Chicago, IL 60612; telephone: 312-942-4811; fax: 312-942-8200; email: Michael_Lin@rush.edu
Alternate corresponding author: Mary K. Hayden, M.D., 1750 W. Harrison St., Rm. 1173, Chicago, IL 60612. telephone: 312-942-8727; fax: 312-942-6787; email: mhayden@rush.edu
Abstract
Background.
In the United States, Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae are increasingly detected in clinical infections; however, the colonization burden of these organisms among short stay and long-term acute care hospitals is unknown.
Methods.
Short stay acute care hospitals with adult intensive care units (ICUs) in the city of Chicago were recruited for two cross-sectional single-day point prevalence surveys (survey 1, July 2010?January 2011; survey 2, January 2011?July 2011). In addition, all long-term acute care hospitals (LTACHs) in the Chicago region (Cook County) were recruited for a single-day point prevalence survey from January?May, 2011. Swab specimens were collected from rectal, inguinal, or urine sites and tested for Enterobacteriaceae carrying bla<SUB>KPC</SUB>.
Results.
We surveyed 24 of 25 eligible short stay acute care hospitals and 7 of 7 eligible LTACHs. Among LTACHs, 30.4% (119 of 391) of patients were colonized with KPC-producing Enterobacteriaceae, compared to 3.3% (30 of 910) of short stay hospital ICU patients (prevalence ratio, 9.2; 95% confidence interval 6.3 to 13.5). All surveyed LTACHs had patients harboring KPC (prevalence range, 10?54%), versus 15 of 24 short stay hospitals (prevalence range, 0?29%). Several patient-level covariates present at the time of survey?LTACH facility-type, mechanical ventilation, and length of stay?were independent risk factors for KPC-producing Enterobacteriaceae colonization.
Conclusions.
We identified high colonization prevalence of KPC-producing Enterobacteriaceae among patients in LTACHs. Patients with chronic medical care needs in long term care facilities may play an important role in the spread of these extremely drug resistant pathogens.
Received March 25, 2013. Accepted June 23, 2013.
? The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
For Permissions, please e-mail: journals.permissions@oup.com.
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The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae
Michael Y. Lin 1, Rosie D. Lyles-Banks 2, Karen Lolans 3, David W. Hines 4, Joel B. Spear 5, Russell Petrak 4, William E. Trick 1,2, Robert A. Weinstein 1,2, Mary K. Hayden 1,3, for the CDC Prevention Epicenters Program (R.A.W.?PI)
Author Affiliations: <SUP>1</SUP>Department of Medicine, Rush University Medical Center, Chicago, U.S.A <SUP>2</SUP>Department of Medicine, Cook County Health and Hospitals System, Chicago, U.S.A <SUP>3</SUP>Department of Pathology, Rush University Medical Center, Chicago, U.S.A <SUP>4</SUP>Metro Infectious Diseases Consultants, LLC, Burr Ridge, U.S.A <SUP>5</SUP>Department of Medicine, St. Joseph Hospital, Chicago, U.S.A
Corresponding author: Michael Y. Lin, M.D., M.P.H., 600 S. Paulina St., Ste 143, Chicago, IL 60612; telephone: 312-942-4811; fax: 312-942-8200; email: Michael_Lin@rush.edu
Alternate corresponding author: Mary K. Hayden, M.D., 1750 W. Harrison St., Rm. 1173, Chicago, IL 60612. telephone: 312-942-8727; fax: 312-942-6787; email: mhayden@rush.edu
Abstract
Background.
In the United States, Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae are increasingly detected in clinical infections; however, the colonization burden of these organisms among short stay and long-term acute care hospitals is unknown.
Methods.
Short stay acute care hospitals with adult intensive care units (ICUs) in the city of Chicago were recruited for two cross-sectional single-day point prevalence surveys (survey 1, July 2010?January 2011; survey 2, January 2011?July 2011). In addition, all long-term acute care hospitals (LTACHs) in the Chicago region (Cook County) were recruited for a single-day point prevalence survey from January?May, 2011. Swab specimens were collected from rectal, inguinal, or urine sites and tested for Enterobacteriaceae carrying bla<SUB>KPC</SUB>.
Results.
We surveyed 24 of 25 eligible short stay acute care hospitals and 7 of 7 eligible LTACHs. Among LTACHs, 30.4% (119 of 391) of patients were colonized with KPC-producing Enterobacteriaceae, compared to 3.3% (30 of 910) of short stay hospital ICU patients (prevalence ratio, 9.2; 95% confidence interval 6.3 to 13.5). All surveyed LTACHs had patients harboring KPC (prevalence range, 10?54%), versus 15 of 24 short stay hospitals (prevalence range, 0?29%). Several patient-level covariates present at the time of survey?LTACH facility-type, mechanical ventilation, and length of stay?were independent risk factors for KPC-producing Enterobacteriaceae colonization.
Conclusions.
We identified high colonization prevalence of KPC-producing Enterobacteriaceae among patients in LTACHs. Patients with chronic medical care needs in long term care facilities may play an important role in the spread of these extremely drug resistant pathogens.
Received March 25, 2013. Accepted June 23, 2013.
? The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
For Permissions, please e-mail: journals.permissions@oup.com.
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