Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Nov;57(9):1246-52.
doi: 10.1093/cid/cit500. Epub 2013 Aug 14.

The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae

Michael Y Lin  1 , Rosie D Lyles-Banks, Karen Lolans, David W Hines, Joel B Spear, Russell Petrak, William E Trick, Robert A Weinstein, Mary K Hayden; Centers for Disease Control and Prevention Epicenters Program
Collaborators, Affiliations

The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae

Michael Y Lin et al. Clin Infect Dis. 2013 Nov.

Abstract

Background: In the United States, Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae are increasingly detected in clinical infections; however, the colonization burden of these organisms among short-stay and long-term acute care hospitals is unknown.

Methods: Short-stay acute care hospitals with adult intensive care units (ICUs) in the city of Chicago were recruited for 2 cross-sectional single-day point prevalence surveys (survey 1, July 2010-January 2011; survey 2, January-July 2011). In addition, all long-term acute care hospitals (LTACHs) in the Chicago region (Cook County) were recruited for a single-day point prevalence survey during January-May 2011. Swab specimens were collected from rectal, inguinal, or urine sites and tested for Enterobacteriaceae carrying blaKPC.

Results: We surveyed 24 of 25 eligible short-stay acute care hospitals and 7 of 7 eligible LTACHs. Among LTACHs, 30.4% (119 of 391) of patients were colonized with KPC-producing Enterobacteriaceae, compared to 3.3% (30 of 910) of short-stay hospital ICU patients (prevalence ratio, 9.2; 95% confidence interval, 6.3-13.5). All surveyed LTACHs had patients harboring KPC (prevalence range, 10%-54%), versus 15 of 24 short-stay hospitals (prevalence range, 0%-29%). Several patient-level covariates present at the time of survey-LTACH facility type, mechanical ventilation, and length of stay-were independent risk factors for KPC-producing Enterobacteriaceae colonization.

Conclusions: We identified high colonization prevalence of KPC-producing Enterobacteriaceae among patients in LTACHs. Patients with chronic medical care needs in long-term care facilities may play an important role in the spread of these extremely drug-resistant pathogens.

Keywords: Klebsiella pneumoniae carbapenemase; carbapenem-resistant Enterobacteriaceae; healthcare epidemiology; intensive care units; long-term care facilities.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts.

All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Colonization prevalence of Klebsiella pneumoniae carbapenemase–producing Enterobacteriaceae among patients in short-stay acute care hospital intensive care units versus long-term acute care hospitals. Solid dots represent aggregate colonization rates, with error bars representing 95% confidence intervals. Each bubble represents a single facility, with bubble size proportional to the number of patients participating in the point prevalence surveys. Short-stay acute care hospitals were surveyed twice; results were aggregated into a single summary prevalence per facility for purpose of this figure. Abbreviations: ICU, intensive care unit; LTACH, long-term acute care hospital.
See this image and copyright information in PMC

Comment in

References

    1. Nordmann P, Naas T, Poirel L. Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2011; 17:1791–8. - PMC - PubMed
    1. Braykov NP, Eber MR, Klein EY, Morgan DJ, Laxmirarayan R. Trends in resistance to carbapenems and third-generation cephalosproins among clinical isolates of Klebsiella pneumoniae in the United States, 1999–2010. Infect Control Hosp Epidemiol 2013; 34:259–68. - PubMed
    1. Gupta N, Limbago BM, Patel JB, Kallen AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011; 53:60–7. - PubMed
    1. Schwaber MJ, Lev B, Israeli A, et al.Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011; 52:848–55. - PubMed
    1. Bratu S, Landman D, Haag R, et al.Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium. Arch Intern Med 2005; 165:1430–5. - PubMed

Publication types

MeSH terms