title: The Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Colonization and Infection among Long-Term Acute Care Hospital Residents.
abstract: OBJECTIVE An improved understanding of carbapenem-resistant Klebsiella pneumoniae (CRKP) in long-term acute care hospitals (LTACHs) is needed. The objective of this study was to assess risk factors for colonization or infection with CRKP in LTACH residents. METHODS A case-control study was performed at a university-affiliated LTACH from 2008 to 2013. Cases were defined as all patients with clinical cultures positive for CRKP and controls were those with clinical cultures positive for carbapenem-susceptible K. pneumoniae (CSKP). A multivariate model was developed to identify risk factors for CRKP infection or colonization. RESULTS A total of 222 patients were identified with K. pneumoniae clinical cultures during the study period; 99 (45%) were case patients and 123 (55%) were control patients. Our multivariate analysis identified factors associated with a significant risk for CRKP colonization or infection: solid organ or stem cell transplantation (OR, 5.05; 95% CI, 1.23-20.8; P=.03), mechanical ventilation (OR, 2.56; 95% CI, 1.24-5.28; P=.01), fecal incontinence (OR, 5.78; 95% CI, 1.52-22.0; P=.01), and exposure in the prior 30 days to meropenem (OR, 3.55; 95% CI, 1.04-12.1; P=.04), vancomycin (OR, 2.94; 95% CI, 1.18-7.32; P=.02), and metronidazole (OR, 4.22; 95% CI, 1.28-14.0; P=.02). CONCLUSIONS Rates of colonization and infection with CRKP were high in the LTACH setting, with nearly half of K. pneumoniae cultures demonstrating carbapenem resistance. Further studies are needed on interventions to limit the emergence of CRKP in LTACHs, including targeted surveillance screening of high-risk patients and effective antibiotic stewardship measures. Infect. Control Hosp. Epidemiol. 2015;37(1):55-60.
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,University of Pennsylvania School of Medicine,Philadelphia,Pennsylvania.
authors.forename: John P
authors.initials: JP
authors.lastname: Mills
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,University of Pennsylvania School of Medicine,Philadelphia,Pennsylvania.
authors.forename: Naasha J
authors.initials: NJ
authors.lastname: Talati
authors.affiliation: 3Department of Pathology and Laboratory Medicine,University of Pennsylvania School of Medicine,Philadelphia,Pennsylvania.
authors.forename: Kevin
authors.initials: K
authors.lastname: Alby
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,University of Pennsylvania School of Medicine,Philadelphia,Pennsylvania.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Han
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015780:Carbapenems / Q000494:pharmacology*; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D024881:Drug Resistance, Bacterial; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects*; D008297:Male; D000077731:Meropenem; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D016377:Organ Transplantation; D012121:Respiration, Artificial; D012307:Risk Factors; D033581:Stem Cell Transplantation; D013845:Thienamycins / Q000627:therapeutic use; D013997:Time Factors; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D013845:Thienamycins; D008795:Metronidazole; D014640:Vancomycin; D000077731:Meropenem