title: Population-based incidence of carbapenem-resistant Klebsiella pneumoniae along the continuum of care, Los Angeles County.
abstract: OBJECTIVE
  Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging multidrug-resistant pathogen associated with higher mortality, longer hospital stays, and increased costs. CRKP was thought to be sporadic in Los Angeles County (LAC); however, the actual incidence is unknown. To address this, LAC declared CRKP a laboratory-reportable disease on June 1, 2010.
  
  
  METHODS
  Laboratory-based community-wide surveillance.
  
  
  METHODS
  Any individual who was identified as CRKP positive. CRKP was defined as a K. pneumoniae isolate resistant to all carbapenems by 2010 Clinical and Laboratory Standards Institute criteria.
  
  
  METHODS
  Laboratory directors of 102 LAC acute care hospitals (ACHs) and 5 reference laboratories were to submit susceptibility testing results for all CRKP-positive specimens. Positive specimens from the same patient within the same calendar month of previous culture were excluded.
  
  
  RESULTS
  A total of 814 reports were received from June 1, 2010, through May 31, 2011, from 69 laboratories; 675 (83%) met the case definition. Cases were reported from ACHs (387 [57%]), long-term ACHs (LTACs; 231 [34%]), and skilled nursing facilities (57 [8%]); an outbreak in 1 LTAC was identified. The pooled mean incidence rate in LAC ACHs and LTACs was 0.46 per 1,000 patient-days; the rate in LTACs (2.54 per 1,000 patient-days) was higher than that in ACHs (0.31 per 1,000 patient-days; P < .001). Sixty-five individuals had multiple incidences, accounting for 147 case reports.
  
  
  CONCLUSIONS
  CRKP is more present in LAC than suspected. Rates were consistently higher in LTACs than in ACHs. Heightened awareness of this problem is needed in all LAC healthcare facilities, as patients access services along the continuum of care.
authors.affiliation: Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA. pmarquez@ph.lacounty.gov
authors.forename: Patricia
authors.initials: P
authors.lastname: Marquez
authors.forename: Dawn
authors.initials: D
authors.lastname: Terashita
authors.forename: David
authors.initials: D
authors.lastname: Dassey
authors.forename: Laurene
authors.initials: L
authors.lastname: Mascola
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015780:Carbapenems / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D003428:Cross Infection / Q000453:epidemiology*; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012866:Skilled Nursing Facilities; D055815:Young Adult; D018440:beta-Lactam Resistance
chemical_list: D015780:Carbapenems