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The Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Colonization and Infection among Long-Term Acute Care Hospital Residents

  • John P Mills (a1), Naasha J Talati (a1) (a2), Kevin Alby (a3) and Jennifer H Han (a1) (a4) (a5)
Abstract
OBJECTIVE

An improved understanding of carbapenem-resistant Klebsiella pneumoniae (CRKP) in long-term acute care hospitals (LTACHs) is needed. The objective of this study was to assess risk factors for colonization or infection with CRKP in LTACH residents.

METHODS

A case-control study was performed at a university-affiliated LTACH from 2008 to 2013. Cases were defined as all patients with clinical cultures positive for CRKP and controls were those with clinical cultures positive for carbapenem-susceptible K. pneumoniae (CSKP). A multivariate model was developed to identify risk factors for CRKP infection or colonization.

RESULTS

A total of 222 patients were identified with K. pneumoniae clinical cultures during the study period; 99 (45%) were case patients and 123 (55%) were control patients. Our multivariate analysis identified factors associated with a significant risk for CRKP colonization or infection: solid organ or stem cell transplantation (OR, 5.05; 95% CI, 1.23–20.8; P=.03), mechanical ventilation (OR, 2.56; 95% CI, 1.24–5.28; P=.01), fecal incontinence (OR, 5.78; 95% CI, 1.52–22.0; P=.01), and exposure in the prior 30 days to meropenem (OR, 3.55; 95% CI, 1.04–12.1; P=.04), vancomycin (OR, 2.94; 95% CI, 1.18–7.32; P=.02), and metronidazole (OR, 4.22; 95% CI, 1.28–14.0; P=.02).

CONCLUSIONS

Rates of colonization and infection with CRKP were high in the LTACH setting, with nearly half of K. pneumoniae cultures demonstrating carbapenem resistance. Further studies are needed on interventions to limit the emergence of CRKP in LTACHs, including targeted surveillance screening of high-risk patients and effective antibiotic stewardship measures.

Infect. Control Hosp. Epidemiol. 2015;37(1):55–60

Copyright
Corresponding author
Address correspondence to Jennifer Han, MD, MSCE, Division of Infectious Diseases, Department of Medicine, 811 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 (jennifer.han@uphs.upenn.edu).
Footnotes
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PREVIOUS PRESENTATION. The results of this study were previously presented as an Oral Abstract Presentation at the Society for Healthcare Epidemiology of America (SHEA) Spring 2015 Conference in Orlando, Florida, on May 16, 2015.

Footnotes
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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