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Multicenter Study
. 2012 Dec;33(12):1193-9.
doi: 10.1086/668435. Epub 2012 Oct 25.

Transfer from high-acuity long-term care facilities is associated with carriage of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae: a multihospital study

Kavitha Prabaker  1 , Michael Y Lin, Margaret McNally, Kartikeya Cherabuddi, Sana Ahmed, Andrea Norris, Karen Lolans, Ruba Odeh, Vishnu Chundi, Robert A Weinstein, Mary K Hayden; Centers for Disease Control and Prevention (CDC) Prevention Epicenters Program
Affiliations
Multicenter Study

Transfer from high-acuity long-term care facilities is associated with carriage of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae: a multihospital study

Kavitha Prabaker et al. Infect Control Hosp Epidemiol. 2012 Dec.

Abstract

Objective: To determine whether transfer from a long-term care facility (LTCF) is a risk factor for colonization with Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae upon acute care hospital admission.

Design: Microbiologic survey and nested case-control study.

Setting: Four hospitals in a metropolitan area (Chicago) with an early KPC epidemic.

Patients: Hospitalized adults.

Methods: Patients transferred from LTCFs were matched 1∶1 to patients admitted from the community by age (± 10 years), admitting clinical service, and admission date (± 2 weeks). Rectal swab specimens were collected within 3 days after admission and tested for KPC-producing Enterobacteriaceae. Demographic and clinical information was extracted from medical records.

Results: One hundred eighty patients from LTCFs were matched to 180 community patients. KPC-producing Enterobacteriaceae colonization was detected in 15 (8.3%) of the LTCF patients and 0 (0%) of the community patients ([Formula: see text]). Prevalence of carriage differed by LTCF subtype: 2 of 135 (1.5%) patients from skilled nursing facilities without ventilator care (SNFs) were colonized upon admission, compared to 9 of 33 (27.3%) patients from skilled nursing facilities with ventilator care (VSNFs) and 4 of 12 (33.3%) patients from long-term acute care hospitals (LTACHs; [Formula: see text]). In a multivariable logistic regression model adjusted for a propensity score that predicted LTCF subtype, patients admitted from VSNFs or LTACHs had 7.0-fold greater odds of colonization (ie, odds ratio; 95% confidence interval, 1.3-42; [Formula: see text]) with KPC-producing Enterobacteriaceae than patients from an SNF.

Conclusions: Patients admitted to acute care hospitals from high-acuity LTCFs (ie, VSNFs and LTACHs) were more likely to be colonized with KPC-producing Enterobacteriaceae than were patients admitted from the community. Identification of healthcare facilities with a high prevalence of colonized patients presents an opportunity for focused interventions that may aid regional control efforts.

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Conflict of interest statement

Potential conflicts of interest. R.O. reports that she has participated in speaker programs for Pfizer. R.A.W. and M.K.H. report that Sage has provided study product (chlorhexidine gluconate–impregnated cloths) at no charge to a group of “third-party” institutions in which they were conducting a clinical trial (unrelated to this article); no money or product was received by them, their employers, or their academic institutions. All other authors report no conflicts of interest relevant to this article. All authors submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and the conflicts that the editors consider relevant to this article are disclosed here.

Figures

FIGURE 1.
FIGURE 1.
Average prevalence and 95% confidence limits of carriage of Klebsiella pneumoniae carbapenemase–producing Enterobacteriaceae among patients from specific long-term care facility (LTCF) subtypes, at the time of acute care hospital admission. SNF, skilled nursing facility without a ventilator unit; VSNF, skilled nursing facility with a ventilator unit; LTACH, long-term acute care hospital.
See this image and copyright information in PMC

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