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

  • Koh Okamoto (a1), Michael Y. Lin (a1), Manon Haverkate (a2), Karen Lolans (a3), Nicholas M. Moore (a3) (a4), Shayna Weiner (a1), Rosie D. Lyles (a5), Donald Blom (a1), Yoona Rhee (a1), Sarah Kemble (a1), Louis Fogg (a6), David W. Hines (a7), Robert A. Weinstein (a1) (a5) and Mary K. Hayden (a1) (a3)...



To identify modifiable risk factors for acquisition of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) colonization among long-term acute-care hospital (LTACH) patients.


Multicenter, matched case-control study.


Four LTACHs in Chicago, Illinois.


Each 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.


From 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.


Higher 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 Epidemiol 2017;38:670–677


Corresponding author

Address correspondence to Koh Okamoto, MD, MS, Department of Infectious Diseases, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo, Tokyo 113-8655, Japan ( or Mary Hayden, MD, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612 (


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PREVIOUS PRESENTATION. The findings reported here were presented in part at IDWeek 2015, San Diego, California, on October 10, 2015 (abstract no. 1332).



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