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

Published online by Cambridge University Press:  23 June 2020

Shawn E. Hawken
Affiliation:
Department of Microbiology & Immunology, University of Michigan Medical School, Ann Arbor, Michigan
Mary K. Hayden
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Karen Lolans
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Rachel D. Yelin
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Robert A. Weinstein
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Michael Y. Lin
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Evan S. Snitkin*
Affiliation:
Department of Microbiology & Immunology, University of Michigan Medical School, Ann Arbor, Michigan Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
*
Author for correspondence: Evan Snitkin, E-mail: esnitkin@umich.edu.

Abstract

Objective:

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.

Type
Original Article
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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