The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae.
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.
Department of Medicine, Rush University Medical Center.
Michael Y
MY
Lin
Rosie D
RD
Lyles-Banks
Karen
K
Lolans
David W
DW
Hines
Joel B
JB
Spear
Russell
R
Petrak
William E
WE
Trick
Robert A
RA
Weinstein
Mary K
MK
Hayden
D000328:Adult; D000368:Aged; D001426:Bacterial Proteins / Q000378:metabolism*; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D002641:Chicago / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D005791:Patient Care; D015995:Prevalence; D013997:Time Factors; D001618:beta-Lactamases / Q000378:metabolism*
D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
Klebsiella pneumoniae carbapenemase; carbapenem-resistant Enterobacteriaceae; healthcare epidemiology; intensive care units; long-term care facilities