Hostname: page-component-76fb5796d-2lccl Total loading time: 0 Render date: 2024-04-25T18:57:04.203Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2015

Caroline J. Thurlow ,
Kavitha Prabaker ,
Michael Y. Lin ,
Karen Lolans ,
Robert A. Weinstein ,
Mary K. Hayden  and
Centers for Disease Control and Prevention Epicenters Program
Caroline J. Thurlow
Affiliation:
Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois Division of Infectious Diseases, John H. Stroger Hospital of Cook County, Chicago, Illinois
Kavitha Prabaker
Affiliation:
Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois Division of Infectious Diseases, John H. Stroger Hospital of Cook County, Chicago, Illinois
Michael Y. Lin
Affiliation:
Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois Division of Infectious Diseases, John H. Stroger Hospital of Cook County, Chicago, Illinois
Karen Lolans
Affiliation:
Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Robert A. Weinstein
Affiliation:
Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois Division of Infectious Diseases, John H. Stroger Hospital of Cook County, Chicago, Illinois
Mary K. Hayden*
Affiliation:
Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois Division of Infectious Diseases, John H. Stroger Hospital of Cook County, Chicago, Illinois
*
Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612 (mhayden@rush.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 1 , January 2013 , pp. 56 - 61
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Munoz-Price, LS. Long-term acute care hospitals. Clin Infect Dis 2009;49(3):438–443.10.1086/600391Google Scholar
2. Gould, CV, Rothenberg, R, Steinberg, JP. Antibiotic resistance in long-term acute care hospitals: the perfect storm. Infect Control Hosp Epidemiol 2006;27(9):920–925.10.1086/507280Google Scholar
3. Endimiani, A, Depasquale, JM, Forero, S, et al. Emergence of bla KPC-containing Klebsiella pneumoniae in a long-term acute care hospital: a new challenge to our healthcare system. J Antimicrob Chemother 2009;64(5):1102–1110.10.1093/jac/dkp327Google Scholar
4. Won, SY, Munoz-Price, LS, Lolans, K, Hota, B, Weinstein, RA, Hayden, MK. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2011;53(6):532–540.10.1093/cid/cir482Google Scholar
5. Centers for Disease Control and Prevention. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR 2009;58:256–260.Google Scholar
6. Wernli, D, Haustein, T, Conly, J, Carmeli, Y, Kickbusch, I, Harbarth, S. A call for action: the application of the International Health Regulations to the global threat of antimicrobial resistance. PLoS Med 2011;8(4):e1001022.10.1371/journal.pmed.1001022Google Scholar
7. Schwaber, MJ, Lev, B, Israeli, A, et al. Containment of a countrywide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011;52(7):848–855.10.1093/cid/cir025Google Scholar
8. Calfee, D, Jenkins, SG. Use of active surveillance cultures to detect asymptomatic colonization with carbapenem-resistant Klebsiella pneumoniae in intensive care unit patients. Infect Control Hosp Epidemiol 2008;29(10):966–968.10.1086/590661Google Scholar
9. Munoz-Price, LS, De La Cuesta, C, Adams, S, et al. Successful eradication of a monoclonal strain of Klebsiella pneumoniae during a K. pneumoniae carbapenemase-producing K. pneumoniae outbreak in a surgical intensive care unit in Miami, Florida. Infect Control Hosp Epidemiol 2010;31(10):1074–1077.10.1086/656243Google Scholar
10. Munoz-Price, LS, Hayden, MK, Lolans, K, et al. Successful control of an outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae at a long-term acute care hospital. Infect Control Hosp Epidemiol 2010;31(4):341–347.10.1086/651097Google Scholar
11. Lerner, A, Adler, A, Abu-Hanna, J, Meitus, I, Navon-Venezia, S, Carmeli, Y. Environmental spread of carbapenem-resistant Enterobacteriaceae (CRE) by patients known to be colonized with CRE. Paper presented at: 51st annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy, September 17-20, 2011; Chicago.Google Scholar
12. Lin, MY, Lyles, RD, Lolans, K, et al. Prevalence of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) among adult patients in intensive care units (ICUs) and long-term acute care hospitals (LTACHs) in the Chicago region. Paper presented at: 49th annual meeting of the Infectious Diseases Society of America, October 20-23, 2011; Boston.Google Scholar
13. Lolans, K, Calvert, K, Won, S, Clark, J, Hayden, MK. Direct ertapenem disk screening method for identification of KPC-producing Klebsiella pneumoniae and Escherichia coli in surveillance swab specimens. J Clin Microbiol 2010;48(3):836–841.10.1128/JCM.01988-09Google Scholar
14. Cole, JM, Schuetz, AN, Hill, CE, Nolte, FS. Development and evaluation of a real-time PCR assay for detection of Klebsiella pneumoniae carbapenemase genes. J Clin Microbiol 2009;47(2): 322–326.10.1128/JCM.01550-08Google Scholar
15. Clinical and Laboratory Standards Institute (CLSI). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically-Approved Standard-Ninth Edition. Wayne, PA: CLSI; 2010. Vol M07-A9E.Google Scholar
16. Weintrob, AC, Roediger, MP, Barber, M, et al. Natural history of colonization with gram-negative multidrug-resistant organisms among hospitalized patients. Infect ControlHosp Epidemiol 2010; 31(4):330–337.10.1086/651304Google Scholar
17. Buehlmann, M, Fankhauser, H, Laffer, R, Bregenzer, T, Widmer, AF. The inguinal skin: an important site of colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae. Infect Control Hosp Epidemiol 2010;31(4):427–428.10.1086/651309Google Scholar
18. Climo, MW, Sepkowitz, KA, Zuccotti, G, et al. The effect of daily bathing with Chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009; 37(6):1858–1865.10.1097/CCM.0b013e31819ffe6dGoogle Scholar
19. Vernon, MO, Hayden, MK, Trick, WE, Hayes, RA, Blom, DW, Weinstein, RA. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006;166(3):306–312.10.1001/archinte.166.3.306Google Scholar
20. Evans, HL, Dellit, TH, Chan, J, Nathens, AB, Maier, RV, Cuschieri, J. Effect of Chlorhexidine whole-body bathing on hospital-acquired infections among trauma patients. Arch Surg 2010; 145(3):240–246.10.1001/archsurg.2010.5Google Scholar
21. Naparstek, L, Carmeli, Y, Chmelnitsky, I, Banin, E, Navon-Venezia, S. Reduced susceptibility to Chlorhexidine among extremely-drug-resistant strains of Klebsiella pneumoniae . J Hosp Infect 2012;81(1):15–19.10.1016/j.jhin.2012.02.007Google Scholar