title: Transfer from high-acuity long-term care facilities is associated with carriage of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae: a multihospital study.
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.
  
  
  METHODS
  Microbiologic survey and nested case-control study.
  
  
  METHODS
  Four hospitals in a metropolitan area (Chicago) with an early KPC epidemic.
  
  
  METHODS
  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.
authors.affiliation: Rush University Medical Center, Chicago, Illinois, USA. kavitha_prabaker@rush.edu
authors.forename: Kavitha
authors.initials: K
authors.lastname: Prabaker
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Lin
authors.forename: Margaret
authors.initials: M
authors.lastname: McNally
authors.forename: Kartikeya
authors.initials: K
authors.lastname: Cherabuddi
authors.forename: Sana
authors.initials: S
authors.lastname: Ahmed
authors.forename: Andrea
authors.initials: A
authors.lastname: Norris
authors.forename: Karen
authors.initials: K
authors.lastname: Lolans
authors.forename: Ruba
authors.initials: R
authors.lastname: Odeh
authors.forename: Vishnu
authors.initials: V
authors.lastname: Chundi
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hayden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000096:biosynthesis*; D015780:Carbapenems; D002353:Carrier State / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D002641:Chicago / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D016001:Confidence Intervals; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000201:enzymology; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology*; D008297:Male; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D016017:Odds Ratio; D015995:Prevalence; D057216:Propensity Score; D012007:Rectum / Q000382:microbiology; D012121:Respiration, Artificial; D012866:Skilled Nursing Facilities / Q000145:classification; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase