title: Carbapenem-resistant Klebsiella pneumoniae in post-acute-care facilities in Israel.
abstract: OBJECTIVE
  To assess the prevalence of and risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) carriage among patients in post-acute-care facilities (PACFs) in Israel.
  
  
  METHODS
  A cross-sectional prevalence survey was conducted in 12 PACFs. Rectal swab samples were obtained from 1,144 patients in 39 [corrected] wards. Risk factors for CRKP carriage were assessed among the cohort. Next, a nested, matched case-control study was conducted to define individual risk factors for colonization. Finally, the cohort of patients with a history of CRKP carriage was characterized to determine risk factors for continuous carriage.
  
  
  RESULTS
  The prevalence of rectal carriage of CRKP among 1,004 patients without a history of CRKP carriage was 12.0%. Independent risk factors for CRKP carriage were prolonged length of stay (odds ratio [OR], 1.001; P < .001), sharing a room with a known carrier (OR, 3.09; P = .02), and increased prevalence of known carriers on the ward (OR, 1.02; P = .013). A policy of screening for carriage on admission was protective (OR, 0.41; P = .03). Risk factors identified in the nested case-control study were antibiotic exposure during the prior 3 months (OR, 1.66; P = .03) and colonization with other resistant pathogens (OR, 1.64; P = .03). Among 140 patients with a history of CRKP carriage, 47% were colonized. Independent risk factors for continued CRKP carriage were antibiotic exposure during the prior 3 months (OR, 3.05; P = .04), receipt of amoxicillin-clavulanate (OR, 4.18; P = .007), and screening within 90 days of the first culture growing CRKP (OR, 2.9; P = .012).
  
  
  CONCLUSIONS
  We found a large reservoir of CRKP in PACFs. Infection-control policies and antibiotic exposure were associated with patient colonization.
authors.affiliation: National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel. debby.bendavid@sheba.health.gov.il
authors.forename: Debby
authors.initials: D
authors.lastname: Ben-David
authors.forename: Samira
authors.initials: S
authors.lastname: Masarwa
authors.forename: Shiri
authors.initials: S
authors.lastname: Navon-Venezia
authors.forename: Hagit
authors.initials: H
authors.lastname: Mishali
authors.forename: Ilan
authors.initials: I
authors.lastname: Fridental
authors.forename: Bina
authors.initials: B
authors.lastname: Rubinovitch
authors.forename: Gill
authors.initials: G
authors.lastname: Smollan
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Schwaber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D002353:Carrier State / Q000453:epidemiology* / Q000635:transmission; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017053:Infection Control / Q000458:organization & administration; D007557:Israel / Q000453:epidemiology; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012866:Skilled Nursing Facilities / Q000458:organization & administration; D055815:Young Adult; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems