scholarly journals The Effectiveness of Routine Daily Chlorhexidine Gluconate Bathing in Reducing Klebsiella pneumoniae Carbapenemase–Producing Enterobacteriaceae Skin Burden among Long-Term Acute Care Hospital Patients

2014 ◽  
Vol 35 (4) ◽  
pp. 440-442 ◽  
Author(s):  
Michael Y. Lin ◽  
Karen Lolans ◽  
Donald W. Blom ◽  
Rosie D. Lyles ◽  
Shayna Weiner ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Chlorhexidine Gluconate ◽  
Care Hospital ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Hospital Patients ◽  
Skin Colonization

We evaluated the effectiveness of daily chlorhexidine gluconate (CHG) bathing in decreasing skin carriage of Klebsiella pneumoniae carbapenemase–producing Enterobacteriaceae (KPC) among long-term acute care hospital patients. CHG bathing reduced KPC skin colonization, particularly when CHG skin concentrations greater than or equal to 128 μg/mL were achieved.

scholarly journals Cohorting KPC+ Klebsiella pneumoniae (KPC-Kp)–positive patients: A genomic exposé of cross-colonization hazards in a long-term acute-care hospital (LTACH)

2020 ◽  
Vol 41 (10) ◽  
pp. 1162-1168
Author(s):  
Shawn E. Hawken ◽  
Mary K. Hayden ◽  
Karen Lolans ◽  
Rachel D. Yelin ◽  
Robert A. Weinstein ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Resistance Genes ◽  
Acute Care Hospital ◽  
Antibiotic Resistance Genes ◽  
Care Hospital ◽  
Cross Transmission ◽  
The Impact

AbstractObjective:Cohorting patients who are colonized or infected with multidrug-resistant organisms (MDROs) protects uncolonized patients from acquiring MDROs in healthcare settings. The potential for cross transmission within the cohort and the possibility of colonized patients acquiring secondary isolates with additional antibiotic resistance traits is often neglected. We searched for evidence of cross transmission of KPC+ Klebsiella pneumoniae (KPC-Kp) colonization among cohorted patients in a long-term acute-care hospital (LTACH), and we evaluated the impact of secondary acquisitions on resistance potential.Design:Genomic epidemiological investigation.Setting:A high-prevalence LTACH during a bundled intervention that included cohorting KPC-Kp–positive patients.Methods:Whole-genome sequencing (WGS) and location data were analyzed to identify potential cases of cross transmission between cohorted patients.Results:Secondary KPC-Kp isolates from 19 of 28 admission-positive patients were more closely related to another patient’s isolate than to their own admission isolate. Of these 19 cases, 14 showed strong genomic evidence for cross transmission (<10 single nucleotide variants or SNVs), and most of these patients occupied shared cohort floors (12 patients) or rooms (4 patients) at the same time. Of the 14 patients with strong genomic evidence of acquisition, 12 acquired antibiotic resistance genes not found in their primary isolates.Conclusions:Acquisition of secondary KPC-Kp isolates carrying distinct antibiotic resistance genes was detected in nearly half of cohorted patients. These results highlight the importance of healthcare provider adherence to infection prevention protocols within cohort locations, and they indicate the need for future studies to assess whether multiple-strain acquisition increases risk of adverse patient outcomes.

scholarly journals Emergence of blaKPC-containing Klebsiella pneumoniae in a long-term acute care hospital: a new challenge to our healthcare system

2009 ◽  
Vol 64 (5) ◽  
pp. 1102-1110 ◽  
Author(s):  
A. Endimiani ◽  
J. M. DePasquale ◽  
S. Forero ◽  
F. Perez ◽  
A. M. Hujer ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Healthcare System ◽  
Acute Care Hospital ◽  
Care Hospital

scholarly journals The Utility of Routine Admission Surveillance Cultures in Long-Term Acute Care Hospital Patients

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Lauren Dutcher ◽  
Naasha Talati ◽  
Jacqueleen Wise ◽  
Jennifer Han
Keyword(s):  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Surveillance Cultures ◽  
Hospital Patients

scholarly journals Long-term acute care hospitals and Georgia Medicaid: Utilization, outcomes, and cost

2016 ◽  
Vol 4 ◽  
pp. 205031211667092
Author(s):  
Evan S. Cole ◽  
Carla Willis ◽  
William C Rencher ◽  
Mei Zhou
Keyword(s):  
Acute Care ◽  
Diagnosis Related Groups ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Risk Scores ◽  
Average Risk ◽  
Care Hospital ◽  
Hospital Patients ◽  
Medicaid Population

Objectives: Because most research on long-term acute care hospitals has focused on Medicare, the objective of this research is to describe the Georgia Medicaid population who received care at a long-term acute care hospital, the type and volume of services provided by these long-term acute care hospitals, and the costs and outcomes of these services. For those with select respiratory conditions, we descriptively compare costs and outcomes to those of patients who received care for the same services in acute care hospitals. Methods: We describe Georgia Medicaid recipients admitted to a long-term acute care hospital between 2011 and 2012. We compare them to a population of Georgia Medicaid recipients admitted to an acute care hospital for one of five respiratory diagnosis-related groups. Measurements used include patient descriptive information, admissions, diagnosis-related groups, length of stay, place of discharge, 90-day episode costs, readmissions, and patient risk scores. Results: We found that long-term acute care hospital admissions for Medicaid patients were fairly low (470 90-day episodes) and restricted to complex cases. We also found that the majority of long-term acute care hospital patients were blind or disabled (71.2%). Compared to patients who stayed at an acute care hospital, long-term acute care hospital patients had higher average risk scores (13.1 versus 9.0), lengths of stay (61 versus 38 days), costs (US$143,898 versus US$115,056), but fewer discharges to the community (28.4% versus 51.8%). Conclusion: We found that the Medicaid population seeking care at long-term acute care hospitals is markedly different than the Medicare populations described in other long-term acute care hospital studies. In addition, our study revealed that Medicaid patients receiving select respiratory care at a long-term acute care hospital were distinct from Medicaid patients receiving similar care at an acute care hospital. Our findings suggest that state Medicaid programs should carefully consider reimbursement policies for long-term acute care hospitals, including bundled payments that cover both the original hospitalization and long-term acute care hospital admission.

scholarly journals Modifiable Risk Factors for the Spread of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae Among Long-Term Acute-Care Hospital Patients

2017 ◽  
Vol 38 (06) ◽  
pp. 670-677 ◽  
Author(s):  
Koh Okamoto ◽  
Michael Y. Lin ◽  
Manon Haverkate ◽  
Karen Lolans ◽  
Nicholas M. Moore ◽  
...  
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Modifiable Risk Factors ◽  
Surveillance Culture ◽  
Care Hospital ◽  
Colonization Pressure ◽  
Comorbidity Index

OBJECTIVETo identify modifiable risk factors for acquisition ofKlebsiella pneumoniaecarbapenemase-producing Enterobacteriaceae (KPC) colonization among long-term acute-care hospital (LTACH) patients.DESIGNMulticenter, matched case-control study.SETTINGFour LTACHs in Chicago, Illinois.PARTICIPANTSEach case patient included in this study had a KPC-negative rectal surveillance culture on admission followed by a KPC-positive surveillance culture later in the hospital stay. Each matched control patient had a KPC-negative rectal surveillance culture on admission and no KPC isolated during the hospital stay.RESULTSFrom June 2012 to June 2013, 2,575 patients were admitted to 4 LTACHs; 217 of 2,144 KPC-negative patients (10.1%) acquired KPC. In total, 100 of these patients were selected at random and matched to 100 controls by LTACH facility, admission date, and censored length of stay. Acquisitions occurred a median of 16.5 days after admission. On multivariate analysis, we found that exposure to higher colonization pressure (OR, 1.02; 95% CI, 1.01–1.04;P=.002), exposure to a carbapenem (OR, 2.25; 95% CI, 1.06–4.77;P=.04), and higher Charlson comorbidity index (OR, 1.14; 95% CI, 1.01–1.29;P=.04) were independent risk factors for KPC acquisition; the odds of KPC acquisition increased by 2% for each 1% increase in colonization pressure.CONCLUSIONSHigher colonization pressure, exposure to carbapenems, and a higher Charlson comorbidity index independently increased the odds of KPC acquisition among LTACH patients. Reducing colonization pressure (through separation of KPC-positive patients from KPC-negative patients using strict cohorts or private rooms) and reducing carbapenem exposure may prevent KPC cross transmission in this high-risk patient population.Infect Control Hosp Epidemiol2017;38:670–677

Risk of Acquiring Carpapenem-resistant Klebsiella Pneumoniae from Bed Contact in a Long-term Acute Care Hospital

2014 ◽  
Vol 42 (6) ◽  
pp. S30-S31 ◽  
Author(s):  
Robert Kelley ◽  
Timothy Wiemken ◽  
Daniel Curran ◽  
Mohammad Khan ◽  
Emily Pacholski ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital

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

2015 ◽  
Vol 37 (1) ◽  
pp. 55-60 ◽  
Author(s):  
John P Mills ◽  
Naasha J Talati ◽  
Kevin Alby ◽  
Jennifer H Han
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Significant Risk ◽  
Acute Care Hospital ◽  
Carbapenem Resistance ◽  
Solid Organ ◽  
Care Hospital ◽  
Carbapenem Resistant

OBJECTIVEAn 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.METHODSA 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.RESULTSA 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).CONCLUSIONSRates 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

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