Risk Factors for Colonization due to Carbapenem-Resistant Enterobacteriaceae among Patients: Exposed to Long-Term Acute Care and Acute Care Facilities

2014 ◽  
Vol 35 (4) ◽  
pp. 398-405 ◽  
Author(s):  
Ashish Bhargava ◽  
Kayoko Hayakawa ◽  
Ethan Silverman ◽  
Samran Haider ◽  
Krishna Chaitanya Alluri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Admission ◽  
Acute Care ◽  
Entire Cohort ◽  
Carbapenem Resistant ◽  
Increased Risk ◽  
Surveillance Programs ◽  
Acute Care Facilities ◽  
Carbapenem Resistant Enterobacteriaceae

Background.This study aimed to identify risk factors associated with carbapenem-resistant Enterobacteriaceae (CRE) colonization among patients screened with rectal cultures upon admission to a hospital or long-term acute care (LTAC) center and to compare risk factors among patients who were screen positive for CRE at the time of hospital admission with those screen positive prior to LTAC admission.Methods.A retrospective nested matched case-control study was conducted from June 2009 to December 2011. Patients with recent LTAC exposure were screened for CRE carriage at the time of hospital admission, and patients admitted to a regional LTAC facility were screened prior to LTAC admission. Cases were patients with a positive CRE screening culture, and controls (matched in a 3:1 ratio to cases) were patients with negative screening cultures.Results.Nine hundred five cultures were performed on 679 patients. Forty-eight (7.1%) cases were matched to 144 controls. One hundred fifty-eight patients were screened upon hospital admission and 521 prior to LTAC admission. Independent predictors for CRE colonization included Charlson's score greater than 3 (odds ratio [OR], 4.85 [95% confidence interval (CI), 1.64–14.41]), immunosuppression (OR, 3.92 [95% CI, 1.08–1.28]), presence of indwelling devices (OR, 5.21 [95% CI, 1.09–2.96]), and prior antimicrobial exposures (OR, 3.89 [95% CI, 0.71–21.47]). Risk factors among patients screened upon hospital admission were similar to the entire cohort. Among patients screened prior to LTAC admission, the characteristics of the CRE-colonized and noncolonized patients were similar.Conclusions.These results can be used to identify patients at increased risk for CRE colonization and to help target active surveillance programs in healthcare settings.

Establishment of a Statewide Network for Carbapenem-Resistant Enterobacteriaceae Prevention in a Low-Incidence Region

2014 ◽  
Vol 35 (4) ◽  
pp. 356-361 ◽  
Author(s):  
Christopher D. Pfeiffer ◽  
Margaret C. Cunningham ◽  
Tasha Poissant ◽  
Jon P. Furuno ◽  
John M. Townes ◽  
...  
Keyword(s):  
Acute Care ◽  
Infection Prevention ◽  
Long Term Care ◽  
Term Care ◽  
Carbapenem Resistant ◽  
Care Facilities ◽  
Low Incidence ◽  
Acute Care Facilities ◽  
Carbapenem Resistant Enterobacteriaceae

Objective.To establish a statewide network to detect, control, and prevent the spread of carbapenem-resistant Enterobacteriaceae (CRE) in a region with a low incidence of CRE infection.Design.Implementation of the Drug Resistant Organism Prevention and Coordinated Regional Epidemiology (DROP-CRE) Network.Setting and Participants.Oregon infection prevention and microbiology laboratory personnel, including 48 microbiology laboratories, 62 acute care facilities, and 140 long-term care facilities.Methods.The DROP-CRE working group, comprising representatives from academic institutions and public health, convened an interdisciplinary advisory committee to assist with planning and implementation of CRE epidemiology and control efforts. The working group established a statewide CRE definition and surveillance plan; increased the state laboratory capacity to perform the modified Hodge test and polymerase chain reaction for carbapenemases in real time; and administered surveys that assessed the needs and capabilities of Oregon infection prevention and laboratory personnel. Results of these inquiries informed CRE education and the response plan.Results.Of 60 CRE reported from November 2010 through April 2013, only 3 were identified as carbapenemase producers; the cases were not linked, and no secondary transmission was found. Microbiology laboratories, acute care facilities, and long-term care facilities reported lacking carbapenemase testing capability, reliable interfacility communication, and CRE awareness, respectively. Survey findings informed the creation of the Oregon CRE Toolkit, a state-specific CRE guide booklet.Conclusions.A regional epidemiology surveillance and response network has been implemented in Oregon in advance of widespread CRE transmission. Prospective surveillance will determine whether this collaborative approach will be successful at forestalling the emergence of this important healthcare-associated pathogen.

scholarly journals How Long-Term Acute Care Hospitals Can Play an Important Role in Controlling Carbapenem-Resistant Enterobacteriaceae in a Region: A Simulation Modeling Study

2020 ◽  
Author(s):  
Bruce Y Lee ◽  
Sarah M Bartsch ◽  
Michael Y Lin ◽  
Lindsey Asti ◽  
Joel Welling ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Control Measures ◽  
Metropolitan Region ◽  
Drug Resistant ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Typically, long-term acute care hospitals (LTACHs) have less experience in and incentives to implementing aggressive infection control for drug-resistant organisms such as carbapenem-resistant Enterobacteriaceae (CRE) than acute care hospitals. Decision makers need to understand how implementing control measures in LTACHs can impact CRE spread regionwide. Using our Chicago metropolitan region agent-based model to simulate CRE spread and control, we estimated that a prevention bundle in only LTACHs decreased prevalence by a relative 4.6%–17.1%, averted 1,090–2,795 new carriers, 273–722 infections and 37–87 deaths over 3 years and saved $30.5–$69.1 million, compared with no CRE control measures. When LTACHs and intensive care units intervened, prevalence decreased by a relative 21.2%. Adding LTACHs averted an additional 1,995 carriers, 513 infections, and 62 deaths, and saved $47.6 million beyond implementation in intensive care units alone. Thus, LTACHs may be more important than other acute care settings for controlling CRE, and regional efforts to control drug-resistant organisms should start with LTACHs as a centerpiece.

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

scholarly journals Outbreak of Carbapenem-Resistant Enterobacteriaceae at a Long-Term Acute Care Hospital: Sustained Reductions in Transmission through Active Surveillance and Targeted Interventions

2012 ◽  
Vol 33 (10) ◽  
pp. 984-992 ◽  
Author(s):  
Amit S. Chitnis ◽  
Pam S. Caruthers ◽  
Agam K. Rao ◽  
JoAnne Lamb ◽  
Robert Lurvey ◽  
...  
Keyword(s):  
Acute Care ◽  
Genetic Relatedness ◽  
Acute Care Hospital ◽  
Public Health Approach ◽  
Care Hospital ◽  
Healthcare Facilities ◽  
Targeted Interventions ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Objective.To describe a Klebsiella pneumoniae carbapenemase (KPC)–producing carbapenem-resistant Enterobacteriaceae (CRE) outbreak and interventions to prevent transmission.Design, Setting, and Patients.Epidemiologic investigation of a CRE outbreak among patients at a long-term acute care hospital (LTACH).Methods.Microbiology records at LTACH A from March 2009 through February 2011 were reviewed to identify CRE transmission cases and cases admitted with CRE. CRE bacteremia episodes were identified during March 2009–July 2011. Biweekly CRE prevalence surveys were conducted during July 2010–July 2011, and interventions to prevent transmission were implemented, including education and auditin? of staff and isolation and cohorting of CRE patients with dedicated nursing staff and shared medical equipment. Trends were evaluated using weighted linear or Poisson regression. CRE transmission cases were included in a case-control study to evaluate risk factors for acquisition. A real-time polymerase chain reaction assay was used to detect the blaKPC gene, and pulsed-field gel electrophoresis was performed to assess the genetic relatedness of isolates.Results.Ninety-nine CRE transmission cases, 16 admission cases (from 7 acute care hospitals), and 29 CRE bacteremia episodes were identified. Significant reductions were observed in CRE prevalence (49% vs 8%), percentage of patients screened with newly detected CRE (44% vs 0%), and CRE bacteremia episodes (2.5 vs 0.0 per 1,000 patient-days). Cases were more likely to have received β-lactams, have diabetes, and require mechanical ventilation. All tested isolates were KPC-producing K. pneumoniae, and nearly all isolates were genetically related.Conclusion.CRE transmission can be reduced in LTACHs through surveillance testing and targeted interventions. Sustainable reductions within and across healthcare facilities may require a regional public health approach.Infect Control Hosp Epidemiol 2012;33(10):984-992

scholarly journals Epidemiology of Carbapenem-Resistant Enterobacteriaceae at a Long-term Acute Care Hospital

2018 ◽  
Vol 5 (10) ◽  
Author(s):  
Teena Chopra ◽  
Christopher Rivard ◽  
Reda A Awali ◽  
Amar Krishna ◽  
Robert A Bonomo ◽  
...  
Keyword(s):  
Acute Care ◽  
Horizontal Transmission ◽  
Acute Care Hospital ◽  
Multidrug Resistant ◽  
Molecular Characteristics ◽  
Study Cohort ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Residents of long-term acute care hospitals (LTACHs) are considered important reservoirs of multidrug-resistant organisms, including Carbapenem-resistant Enterobacteriaceae (CRE). We conducted this study to define the characteristics of CRE-infected/colonized patients admitted to an LTACH and the molecular characteristics of the CRE isolates. Methods This retrospective study was conducted to collect information on demographic and comorbid conditions in CRE-colonized/infected patients admitted to a 77-bed LTACH in Detroit between January 2011 and July 2012. Data pertaining to hospital-related exposures were collected for 30 days before positive CRE culture. Polymerase chain reaction (PCR) gene amplification, repetitive sequence–based PCR, and multilocus sequence typing (MLST) were performed on 8 of the CRE isolates. Results The study cohort included 30 patients with CRE-positive cultures, 24 (80%) with infections, and 6 (20%) with colonization. The mean age of cohort was 69 ±12.41 years; 19 (63%) patients were ventilator-dependent, and 20 (67%) were treated with at least 1 antibiotic. Twenty-three (77%) patients had CRE detected following LTACH admission, and the median days from admission to CRE detection in these patients (interquartile range) was 25 (11–43). Seven more patients were already positive for CRE at the time of LTACH admission. Molecular genotyping and MLST of 8 CRE isolates demonstrated that all isolates belonged to the same strain type (ST258) and contained the blaKPC-3 sequence. Conclusions The majority of patients with CRE presented several days to weeks after LTACH admission, indicating possible organism acquisition in the LTACH itself. The genetic similarity of the CRE isolates tested could further indicate the occurrence of horizontal transmission in the LTACH or simply be representative of the regionally dominant strain.

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