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

Published online by Cambridge University Press:  11 April 2017

Koh Okamoto ,
Michael Y. Lin ,
Manon Haverkate ,
Karen Lolans ,
Nicholas M. Moore ,
Shayna Weiner ,
Rosie D. Lyles ,
Donald Blom ,
Yoona Rhee  and
Sarah Kemble
...Show all authors
Koh Okamoto*
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States
Michael Y. Lin
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States
Manon Haverkate
Affiliation:
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
Karen Lolans
Affiliation:
Department of Pathology, Rush University Medical Center, Chicago, Illinois, United States
Nicholas M. Moore
Affiliation:
Department of Pathology, Rush University Medical Center, Chicago, Illinois, United States Department of Medical Laboratory Science, Rush University Medical Center, Chicago, Illinois, United States
Shayna Weiner
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States
Rosie D. Lyles
Affiliation:
Department of Medicine, Division of Infectious Diseases, Cook County Health and Hospitals System, Chicago, Illinois, United States
Donald Blom
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States
Yoona Rhee
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States
Sarah Kemble
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States
Louis Fogg
Affiliation:
Department of Nursing, Rush University Medical Center, Chicago, Illinois, United States
David W. Hines
Affiliation:
Metro Infectious Disease Consultants, LLC, Burr Ridge, Illinois, United States
Robert A. Weinstein
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States Department of Medicine, Division of Infectious Diseases, Cook County Health and Hospitals System, Chicago, Illinois, United States
Mary K. Hayden*
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States Department of Pathology, Rush University Medical Center, Chicago, Illinois, United States
*
Address correspondence to Koh Okamoto, MD, MS, Department of Infectious Diseases, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo, Tokyo 113-8655, Japan (kokamoto-tky@umin.ac.jp) or Mary Hayden, MD, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612 (mhayden@rush.edu).
Address correspondence to Koh Okamoto, MD, MS, Department of Infectious Diseases, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo, Tokyo 113-8655, Japan (kokamoto-tky@umin.ac.jp) or Mary Hayden, MD, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612 (mhayden@rush.edu).
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Abstract

OBJECTIVE

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

DESIGN

Multicenter, matched case-control study.

SETTING

Four LTACHs in Chicago, Illinois.

PARTICIPANTS

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.

RESULTS

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.

CONCLUSIONS

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 6 , June 2017 , pp. 670 - 677
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

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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