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Anatomic Sites of Patent Colonization and Environmental Contamination with Klebsiella pneumoniae Carbapenemase—Producing Enterobacteriaceae at Long-Term Acute Care Hospitals

  • Caroline J. Thurlow (a1) (a2), Kavitha Prabaker (a1) (a2), Michael Y. Lin (a1) (a2), Karen Lolans (a1), Robert A. Weinstein (a1) (a2), Mary K. Hayden (a1) (a2) and Centers for Disease Control and Prevention Epicenters Program...



To determine anatomic sites of colonization in patients and to assess environmental contamination with Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae.

Design, Setting, and Patients.

We conducted a cross-sectional microbiologic survey of 33 patients and their environments at 6 long-term acute care hospitals (LTACHs) in metropolitan Chicago. Swab samples of anatomic sites and inanimate surfaces in patients' rooms and common areas were cultured. bla KPC was verified by polymerase chain reaction. Patient charts were reviewed for covariates known to be associated with colonization and environmental contamination.


Mean age was 66 years. Median length of stay prior to surveillance was 50 days. Thirty (91%) patients were mechanically ventilated, 32 (97%) were bedbound, and 27 (82%) had fecal incontinence. Of the 24 patients with KPC-producing Enterobacteriaceae recovered from 1 or more anatomic sites, 23 (96%) had KPC-producing Enterobacteriaceae detected at 1 or more skin sites. Skin colonization was more common in patients with positive rectal/stool swab cultures or positive clinical cultures (P <.001). Rectal/stool swab was the single most sensitive specimen for detecting KPC-producing Enterobacteriaceae colonization (sensitivity, 88%; 95% confidence interval [CI], 68%-97%); addition of inguinal skin swab culture resulted in detection of all colonized patients (sensitivity, 100%; 95% CI, 86%-100%). Only 2 (0.5%) of 371 environmental specimens grew KPC-producing Enterobacteriaceae.


Culture of more than 1 anatomic site was required to detect all KPC-producing Enterobacteriaceae-colonized Patients. Skin colonization was common, but environmental contamination was rare. These results can guide development of multimodal interventions for control of KPC-producing Enterobacteriaceae in LTACHs.


Corresponding author

Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612 (


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1. Munoz-Price, LS. Long-term acute care hospitals. Clin Infect Dis 2009;49(3):438443.
2. Gould, CV, Rothenberg, R, Steinberg, JP. Antibiotic resistance in long-term acute care hospitals: the perfect storm. Infect Control Hosp Epidemiol 2006;27(9):920925.
3. 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):11021110.
4. Won, SY, Munoz-Price, LS, Lolans, K, Hota, B, Weinstein, RA, Hayden, MK. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2011;53(6):532540.
5. Centers for Disease Control and Prevention. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR 2009;58:256260.
6. Wernli, D, Haustein, T, Conly, J, Carmeli, Y, Kickbusch, I, Harbarth, S. A call for action: the application of the International Health Regulations to the global threat of antimicrobial resistance. PLoS Med 2011;8(4):e1001022.
7. Schwaber, MJ, Lev, B, Israeli, A, et al. Containment of a countrywide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011;52(7):848855.
8. 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):966968.
9. Munoz-Price, LS, De La Cuesta, C, Adams, S, et al. Successful eradication of a monoclonal strain of Klebsiella pneumoniae during a K. pneumoniae carbapenemase-producing K. pneumoniae outbreak in a surgical intensive care unit in Miami, Florida. Infect Control Hosp Epidemiol 2010;31(10):10741077.
10. 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):341347.
11. Lerner, A, Adler, A, Abu-Hanna, J, Meitus, I, Navon-Venezia, S, Carmeli, Y. Environmental spread of carbapenem-resistant Enterobacteriaceae (CRE) by patients known to be colonized with CRE. Paper presented at: 51st annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy, September 17-20, 2011; Chicago.
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.
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):836841.
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): 322326.
15. Clinical and Laboratory Standards Institute (CLSI). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically-Approved Standard-Ninth Edition. Wayne, PA: CLSI; 2010. Vol M07-A9E.
16. Weintrob, AC, Roediger, MP, Barber, M, et al. Natural history of colonization with gram-negative multidrug-resistant organisms among hospitalized patients. Infect ControlHosp Epidemiol 2010; 31(4):330337.
17. Buehlmann, M, Fankhauser, H, Laffer, R, Bregenzer, T, Widmer, AF. The inguinal skin: an important site of colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae. Infect Control Hosp Epidemiol 2010;31(4):427428.
18. Climo, MW, Sepkowitz, KA, Zuccotti, G, et al. The effect of daily bathing with Chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009; 37(6):18581865.
19. Vernon, MO, Hayden, MK, Trick, WE, Hayes, RA, Blom, DW, Weinstein, RA. 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):306312.
20. Evans, HL, Dellit, TH, Chan, J, Nathens, AB, Maier, RV, Cuschieri, J. Effect of Chlorhexidine whole-body bathing on hospital-acquired infections among trauma patients. Arch Surg 2010; 145(3):240246.
21. Naparstek, L, Carmeli, Y, Chmelnitsky, I, Banin, E, Navon-Venezia, S. Reduced susceptibility to Chlorhexidine among extremely-drug-resistant strains of Klebsiella pneumoniae . J Hosp Infect 2012;81(1):1519.


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