title: Screening of nursing home residents for colonization with carbapenem-resistant Enterobacteriaceae admitted to acute care hospitals: Incidence and risk factors.
abstract: BACKGROUND
  There are increasing reports of multidrug-resistant gram-negative bacilli in nursing homes and acute care hospitals.
  
  
  METHODS
  We performed a point prevalence survey to detect fecal carriage of gram-negative bacteria carrying carbapenem resistance genes or which were otherwise resistant to carbapenem antibiotics among 500 consecutive admissions from local nursing homes to 2 hospitals in Providence, Rhode Island. We performed a case-control study to identify risk factors associated with carriage of carbapenem-resistant Enterobacteriaceae (CRE).
  
  
  RESULTS
  There were 404 patients with 500 hospital admissions during which they had rectal swab samples cultured. Fecal carriage of any carbapenem-resistant or carbapenemase- producing gram-negative bacteria was found in 23 (4.6%) of the 500 hospital admissions, including 7 CRE (1.4%), 2 (0.4%) of which were Klebsiella pneumoniae carbapenemase (ie, blaKPC) producing (CPE) Citrobacter freundii, 1 of which was carbapenem susceptible by standard testing methods. Use of a gastrostomy tube was associated with CRE carriage (P = .04). We demonstrated fecal carriage of carbapenem-resistant or carbapenemase-producing gram-negative bacteria in 4.6% of nursing home patients admitted to 2 acute care hospitals, but only 0.4% of such admissions were patients with fecal carriage of CPE. Use of gastrostomy tubes was associated with fecal carriage of gram-negative bacteria with detectable carbapenem resistance.
  
  
  CONCLUSIONS
  CRE fecal carriage is uncommon in our hospital admissions from nursing homes.
authors.affiliation: Division of Infectious Diseases, Rhode Island Hospital, Providence, RI.
authors.forename: Cheston B
authors.initials: CB
authors.lastname: Cunha
authors.affiliation: Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Kassakian
authors.affiliation: Cepheid, Sunnyvale, CA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Chan
authors.affiliation: Cepheid, Sunnyvale, CA.
authors.forename: Fred C
authors.initials: FC
authors.lastname: Tenover
authors.affiliation: Division of Infectious Diseases, Rhode Island Hospital, Providence, RI.
authors.forename: Panos
authors.initials: P
authors.lastname: Ziakas
authors.affiliation: Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI.
authors.forename: Kimberle C
authors.initials: KC
authors.lastname: Chapin
authors.affiliation: Division of Infectious Diseases, Rhode Island Hospital, Providence, RI; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology and Infection Control, Rhode Island Hospital, Providence, RI. Electronic address: lmermel@lifespan.org.
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Mermel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000235:genetics*; D015780:Carbapenems / Q000494:pharmacology*; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D012237:Rhode Island / Q000453:epidemiology; D012307:Risk Factors; D055815:Young Adult; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Carbapenem resistance; Carbapenem-resistant Enterobacteriaceae; Carbapenemase-producing Enterobacteriaceae; Multidrug resistant organisms