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Outbreak of Carbapenem-Resistant Enterobacteriaceae at a Long-Term Acute Care Hospital: Sustained Reductions in Transmission through Active Surveillance and Targeted Interventions

Published online by Cambridge University Press:  02 January 2015

Amit S. Chitnis*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia Office of Workforce and Career Development, Epidemic Intelligence Service, CDC, Atlanta, Georgia
Pam S. Caruthers
Affiliation:
Division of Infection Prevention, Kindred Hospital Bay Area-St. Petersburg, St. Petersburg, Florida
Agam K. Rao
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia Office of Workforce and Career Development, Epidemic Intelligence Service, CDC, Atlanta, Georgia
JoAnne Lamb
Affiliation:
Epidemiology Program, Disease Control Division, Pinellas County Health Department, St. Petersburg, Florida
Robert Lurvey
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
Valery Beau De Rochars
Affiliation:
Office of Workforce and Career Development, Epidemic Intelligence Service, CDC, Atlanta, Georgia Division of Disease Control, Bureau of Epidemiology, Florida Department of Health, Tallahassee, Florida
Brandon Kitchel
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
Margarita Cancio
Affiliation:
Division of Infection Prevention, Kindred Hospital Bay Area-St. Petersburg, St. Petersburg, Florida
Thomas J. Török
Affiliation:
Division of Disease Control, Bureau of Epidemiology, Florida Department of Health, Tallahassee, Florida Career Epidemiology Field Office Program, Office of Public Health Preparedness and Response, CDC, Atlanta, Georgia
Alice Y. Guh
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
Carolyn V. Gould
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
Matthew E. Wise
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
*
1600 Clifton Road, MS A-24, Atlanta, GA 30333 (amit.chitnis@cdph.ca.gov)

Abstract

Objective.

To describe a Klebsiella pneumoniae carbapenemase (KPC)–producing carbapenem-resistant Enterobacteriaceae (CRE) outbreak and interventions to prevent transmission.

Design, Setting, and Patients.

Epidemiologic investigation of a CRE outbreak among patients at a long-term acute care hospital (LTACH).

Methods.

Microbiology records at LTACH A from March 2009 through February 2011 were reviewed to identify CRE transmission cases and cases admitted with CRE. CRE bacteremia episodes were identified during March 2009–July 2011. Biweekly CRE prevalence surveys were conducted during July 2010–July 2011, and interventions to prevent transmission were implemented, including education and auditin? of staff and isolation and cohorting of CRE patients with dedicated nursing staff and shared medical equipment. Trends were evaluated using weighted linear or Poisson regression. CRE transmission cases were included in a case-control study to evaluate risk factors for acquisition. A real-time polymerase chain reaction assay was used to detect the blaKPC gene, and pulsed-field gel electrophoresis was performed to assess the genetic relatedness of isolates.

Results.

Ninety-nine CRE transmission cases, 16 admission cases (from 7 acute care hospitals), and 29 CRE bacteremia episodes were identified. Significant reductions were observed in CRE prevalence (49% vs 8%), percentage of patients screened with newly detected CRE (44% vs 0%), and CRE bacteremia episodes (2.5 vs 0.0 per 1,000 patient-days). Cases were more likely to have received β-lactams, have diabetes, and require mechanical ventilation. All tested isolates were KPC-producing K. pneumoniae, and nearly all isolates were genetically related.

Conclusion.

CRE transmission can be reduced in LTACHs through surveillance testing and targeted interventions. Sustainable reductions within and across healthcare facilities may require a regional public health approach.

Infect Control Hosp Epidemiol 2012;33(10):984-992

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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