title: Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) in brain and spinal cord injury patients: potential for prolonged colonization.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To determine the prevalence of brain and spinal cord injury (BSCI) patients among all patients with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) and to evaluate clinical characteristics and duration of colonization.
  
  
  METHODS
  Tertiary care academic medical center.
  
  
  METHODS
  Electronic medical records of BSCI patients with KPC-KP from February 2009 to December 2014 were reviewed to determine clinical characteristics. Patients with multiple KPC-KPs were defined as those with isolates in different calendar months, and patients with a single positive isolate were compared with those with repeatedly positive isolates. Variables with a P-value of ⩽0.05 were considered statistically significant. Two archived isolates recovered from separate cultures of the same patient were compared with pulsed-field gel electrophoresis to calculate the duration of colonization.
  
  
  RESULTS
  Of the 218 patients with KPC-KP, 86 (39%) had BSCI and 27 (31%) had multiple KPC-KPs. The KPC-KPs from 20 (74%) patients with multiple isolates were available for analysis. Patients with repeated positive isolates were more likely to be younger (P=0.05), African American (P=0.05), suffer gunshot injuries (P=0.01) and other trauma (P=0.03) and have decubitus ulcers (P=0.05). Of the 20 patients with multiple isolates for analysis, 13 (65%) patients were colonized with the same strain type over time, and the strain persisted on average 373 days.
  
  
  CONCLUSIONS
  BSCI patients comprise a significant percentage of our KPC-KP population. Owing to repeated hospitalizations and prolonged colonization, they represent a substantial reservoir for these multidrug-resistant pathogens.
authors.affiliation: Lyons Township High School, LaGrange, IL, USA.
authors.forename: N R
authors.initials: NR
authors.lastname: Zembower
authors.affiliation: Walter Payton College Prep, Chicago, IL, USA.
authors.forename: A
authors.initials: A
authors.lastname: Zhu
authors.affiliation: Microbiology Laboratory, Department of Pathology, Northwestern Memorial Hospital, Chicago, IL, USA.
authors.forename: M
authors.initials: M
authors.lastname: Malczynski
authors.affiliation: Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: C
authors.initials: C
authors.lastname: Qi
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D001426:Bacterial Proteins / Q000378:metabolism*; D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D002641:Chicago; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D007710:Klebsiella Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology* / Q000628:therapy; D007711:Klebsiella pneumoniae / Q000254:growth & development / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D062606:Tertiary Care Centers; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase