title: Spread of KPC-producing carbapenem-resistant Enterobacteriaceae: the importance of super-spreaders and rectal KPC concentration.
abstract: Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae is a pathogen causing an epidemic of carbapenem-resistant Enterobacteriaceae (CRE) in healthcare settings in developed countries. The spread is primarily by patient-to-patient transmission. Understanding the mode of spread is important for designing effective control measures. We studied CRE dissemination by quantifying environmental contamination from the vicinity of 34 carriers using selective contact plates. We examined rectal CRE concentrations and clinical characteristics and correlated these with environmental contamination. Eight (24%) carriers were non-spreaders: no CRE was detected in their vicinity. Faecal continence was the only independent predictor of being a non-spreader. Among the 26 spreaders, we identified a distinct group of six (18%) super-spreaders who accounted for 79% of environmental colonies detected. Super-spreaders were likely to have high rectal CRE concentrations and to have been admitted with respiratory disease. CRE spread to the environment follows the 20/80 rule: 20% of carriers are responsible for 80% of shedding and may play a central role in CRE transmission.
authors: Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel.
authors: A
authors: A
authors: Lerner
authors: Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel.
authors: A
authors: A
authors: Adler
authors: Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel.
authors: J
authors: J
authors: Abu-Hanna
authors: Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel.
authors: S
authors: S
authors: Cohen Percia
authors: Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel.
authors: M
authors: M
authors: Kazma Matalon
authors: Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel. Electronic address: yehudac@tlvmc.gov.il.
authors: Y
authors: Y
authors: Carmeli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000032:analysis*; D015780:Carbapenems / Q000494:pharmacology*; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D018562:Disease Transmission, Infectious; D004783:Environmental Microbiology; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000737:chemistry; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000032:analysis*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Carbapenem-resistant Enterobacteriaceae; Klebsiella pneumoniae carbapenemase; environmental contamination; rectal swabs; super-spreaders