scholarly journals Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae in a Network of Long-Term Acute Care Hospitals

2016 ◽  
pp. ciw856 ◽  
Author(s):  
Jennifer H. Han ◽  
Ellie J.C. Goldstein ◽  
Jacqueleen Wise ◽  
Warren B. Bilker ◽  
Pam Tolomeo ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Carbapenem Resistant

scholarly journals Duration of Colonization With Klebsiella pneumoniae Carbapenemase-Producing Bacteria at Long-Term Acute Care Hospitals in Chicago, Illinois

2016 ◽  
Vol 3 (4) ◽  
Author(s):  
Manon R. Haverkate ◽  
Shayna Weiner ◽  
Karen Lolans ◽  
Nicholas M. Moore ◽  
Robert A. Weinstein ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Median Duration ◽  
Acute Care Hospitals ◽  
Interval Censoring ◽  
Control Measures ◽  
Likelihood Method ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Patients At Risk

Abstract Background.  High prevalence of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae has been reported in long-term acute care hospitals (LTACHs), in part because of frequent readmissions of colonized patients. Knowledge of the duration of colonization with KPC is essential to identify patients at risk of KPC colonization upon readmission and to make predictions on the effects of transmission control measures. Methods.  We analyzed data on surveillance isolates that were collected at 4 LTACHs in the Chicago region during a period of bundled interventions, to simultaneously estimate the duration of colonization during an LTACH admission and between LTACH (re)admissions. A maximum-likelihood method was used, taking interval-censoring into account. Results.  Eighty-three percent of patients remained colonized for at least 4 weeks, which was the median duration of LTACH stay. Between LTACH admissions, the median duration of colonization was 270 days (95% confidence interval, 91–∞). Conclusions.  Only 17% of LTACH patients lost colonization with KPC within 4 weeks. Approximately half of the KPC-positive patients were still carriers when readmitted after 9 months. Infection control practices should take prolonged carriage into account to limit transmission of KPCs in LTACHs.

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

2013 ◽  
Vol 34 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Caroline J. Thurlow ◽  
Kavitha Prabaker ◽  
Michael Y. Lin ◽  
Karen Lolans ◽  
Robert A. Weinstein ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Environmental Contamination ◽  
Acute Care Hospitals ◽  
Anatomic Site ◽  
Cross Sectional ◽  
Mechanically Ventilated ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Skin Colonization

Objective.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. blaKPC was verified by polymerase chain reaction. Patient charts were reviewed for covariates known to be associated with colonization and environmental contamination.Results.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.Conclusions.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.

scholarly journals The Importance of Long-term Acute Care Hospitals in the Regional Epidemiology of Klebsiella pneumoniae Carbapenemase–Producing Enterobacteriaceae

2013 ◽  
Vol 57 (9) ◽  
pp. 1246-1252 ◽  
Author(s):  
Michael Y. Lin ◽  
Rosie D. Lyles-Banks ◽  
Karen Lolans ◽  
David W. Hines ◽  
Joel B. Spear ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Klebsiella Pneumoniae Carbapenemase

scholarly journals 1261. Antimicrobial Susceptibilities of Carbapenem-Resistant Klebsiella pneumoniae (CRKP) Isolates from a Multi-state Network of Long-term Acute Care Hospitals (LTACHs)

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S719-S719
Author(s):  
Helen L Zhang ◽  
Jennifer Han ◽  
Kevin Alby ◽  
Zena Lapp ◽  
Evan Snitkin ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Drug Administration ◽  
Southern California ◽  
Food And Drug Administration ◽  
Cross Resistance ◽  
Carbapenem Resistant ◽  
Post Marketing ◽  
Acute Care Facilities

Abstract Background CRKP infection is common among LTACH patients. However, CRKP antimicrobial susceptibility testing (AST) with newer antibiotics has not been described in this population. In this study, we performed AST on CRKP in LTACHs. Methods CRKP clinical cultures were collected from 21 Kindred Healthcare LTACHs (12 southern California, 6 Texas, 2 Florida, 1 Kentucky) from 8/1/14-7/25/15. AST was performed using a custom SensititreTM broth microdilution panel (ThermoFisher Scientific, Waltham, MA). 2021 Clinical & Laboratory Standards Institute interpretive criteria were used for all agents except plazomicin (PLZ), for which US Food and Drug Administration breakpoints were used. Results 459 CRKP clinical isolates were collected, including 254 (55.5%) respiratory, 155 (33.8%) urine, 39 (8.5%) blood, and 10 (2.2%) wound cultures. Most (419, 91.0%) were from southern California. 151 (32.9%) were colistin-resistant. 42 (9.2%) isolates were non-susceptible to meropenem-vaborbactam (MVB), 16 (8.9%) to imipenem-relebactam (IPR), 4 (0.9%) to ceftazidime-avibactam (CZA), and 3 (0.7%) to PLZ. Cross-resistance patterns are shown in Table 1. Among southern California facilities, there was significant inter-facility variation in MVB non-susceptibility (Pearson’s chi-squared test, p=0.005) but not in CZA, IPR, or PLZ non-susceptibility. Table 1. Cross-resistance to antimicrobials among carbapenem-resistant Klebsiella pneumoniae isolates from 21 Kindred long-term acute care facilities, August 1, 2014 – July 25, 2015 (N=459). Number of isolates and column percentages reported. 2021 Clinical & Laboratory Standards Institute interpretive criteria are used for all agents except for PLZ, for which US Food and Drug Administration breakpoints are used. Abbreviations: CST = colistin. CZA = ceftazidime-avibactam. I = intermediate. IPR = imipenem-relebactam. MIC = minimum inhibitory concentration. MVB = meropenem-vaborbactam. PLZ = plazomicin. R = resistant. S = susceptible. Conclusion In this sample of CRKP isolates from LTACHs in 2014-2015, nearly 10% of isolates were non-susceptible to MVB or IPR, respectively, despite neither agent being commercially available at the time. In contrast, there was a low prevalence of non-susceptibility to CZA, which received initial US Food and Drug Association approval in 2/2015, and PLZ, which was not commercially available during the study period. Cross-resistance between CZA and carbapenem/beta-lactamase combination antibiotics was uncommon. Future studies should evaluate CRKP susceptibilities to new agents in post-marketing cohorts and identify risk factors for resistance. Disclosures Jennifer Han, MD, MSCE, GlaxoSmithKline (Employee, Shareholder) Ebbing Lautenbach, MD, MPH, MSCE, Merck (Other Financial or Material Support, Member of Data and Safety Monitoring Board (DSMB))

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