title: Duration of Colonization WithKlebsiella pneumoniaeCarbapenemase-Producing Bacteria at Long-Term Acute Care Hospitals in Chicago, Illinois.
abstract: Background.High prevalence ofKlebsiella pneumoniaecarbapenemase (KPC)-producingEnterobacteriaceaehas been reported in long-term acute care hospitals (LTACHs), in part because of frequent readmissions of colonized patients. Knowledge of the duration of colonization with KPC is essential to identify patients at risk of KPC colonization upon readmission and to make predictions on the effects of transmission control measures.Methods.We analyzed data on surveillance isolates that were collected at 4 LTACHs in the Chicago region during a period of bundled interventions, to simultaneously estimate the duration of colonization during an LTACH admission and between LTACH (re)admissions. A maximum-likelihood method was used, taking interval-censoring into account.Results.Eighty-three percent of patients remained colonized for at least 4 weeks, which was the median duration of LTACH stay. Between LTACH admissions, the median duration of colonization was 270 days (95% confidence interval, 91-∞).Conclusions.Only 17% of LTACH patients lost colonization with KPC within 4 weeks. Approximately half of the KPC-positive patients were still carriers when readmitted after 9 months. Infection control practices should take prolonged carriage into account to limit transmission of KPCs in LTACHs.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht; Department of Medicine, Division of Infectious Diseases, Rush University Medical Center.
authors.forename: Manon R
authors.initials: MR
authors.lastname: Haverkate
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Rush University Medical Center.
authors.forename: Shayna
authors.initials: S
authors.lastname: Weiner
authors.affiliation: Department of Pathology , Rush University Medical Center.
authors.forename: Karen
authors.initials: K
authors.lastname: Lolans
authors.affiliation: Department of Pathology , Rush University Medical Center.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Moore
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Rush University Medical Center; Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht; Department of Medical Microbiology, University Medical Center Utrecht.
authors.forename: Marc J M
authors.initials: MJ
authors.lastname: Bonten
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Rush University Medical Center; Department of Pathology, Rush University Medical Center.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hayden
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht; Department of Mathematics, Utrecht University, the Netherlands.
authors.forename: Martin C J
authors.initials: MC
authors.lastname: Bootsma
keywords: KPC; LTACH; carbapenemase; duration of colonization