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Modeling Spread of KPC-Producing Bacteria in Long-Term Acute Care Hospitals in the Chicago Region, USA

  • Manon R. Haverkate (a1) (a2), Martin C. J. Bootsma (a1) (a3), Shayna Weiner (a2), Donald Blom (a2), Michael Y. Lin (a2), Karen Lolans (a4), Nicholas M. Moore (a5), Rosie D. Lyles (a6), Robert A. Weinstein (a2) (a6), Marc J. M. Bonten (a1) (a7) and Mary K. Hayden (a2) (a4)...
Abstract
OBJECTIVE

Prevalence of bla KPC-encoding Enterobacteriaceae (KPC) in Chicago long-term acute care hospitals (LTACHs) rose rapidly after the first recognition in 2007. We studied the epidemiology and transmission capacity of KPC in LTACHs and the effect of patient cohorting.

METHODS

Data were available from 4 Chicago LTACHs from June 2012 to June 2013 during a period of bundled interventions. These consisted of screening for KPC rectal carriage, daily chlorhexidine bathing, medical staff education, and 3 cohort strategies: a pure cohort (all KPC-positive patients on 1 floor), single rooms for KPC-positive patients, and a mixed cohort (all KPC-positive patients on 1 floor, supplemented with KPC-negative patients). A data-augmented Markov chain Monte Carlo (MCMC) method was used to model the transmission process.

RESULTS

Average prevalence of KPC colonization was 29.3%. On admission, 18% of patients were colonized; the sensitivity of the screening process was 81%. The per admission reproduction number was 0.40. The number of acquisitions per 1,000 patient days was lowest in LTACHs with a pure cohort ward or single rooms for colonized patients compared with mixed-cohort wards, but 95% credible intervals overlapped.

CONCLUSIONS

Prevalence of KPC in LTACHs is high, primarily due to high admission prevalence and the resultant impact of high colonization pressure on cross transmission. In this setting, with an intervention in place, patient-to-patient transmission is insufficient to maintain endemicity. Inclusion of a pure cohort or single rooms for KPC-positive patients in an intervention bundle seemed to limit transmission compared to use of a mixed cohort.

Infect Control Hosp Epidemiol 2015;36(10):1148–1154

Copyright
Corresponding author
Address correspondence to Manon R. Haverkate, Huispostnummer Geuns 5.02, Heidelberglaan 100, 3584 CK Utrecht (m.r.haverkate-2@umcutrecht.nl).
Footnotes
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Preliminary results from this study were presented at IDWeek 2014; October 8–12, 2014, Philadelphia, Pennsylvania, USA.

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