title: Modifiable Risk Factors for the Spread of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae Among Long-Term Acute-Care Hospital Patients.
abstract: OBJECTIVE To identify modifiable risk factors for acquisition of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) colonization among long-term acute-care hospital (LTACH) patients. DESIGN Multicenter, matched case-control study. SETTING Four LTACHs in Chicago, Illinois. PARTICIPANTS Each case patient included in this study had a KPC-negative rectal surveillance culture on admission followed by a KPC-positive surveillance culture later in the hospital stay. Each matched control patient had a KPC-negative rectal surveillance culture on admission and no KPC isolated during the hospital stay. RESULTS From June 2012 to June 2013, 2,575 patients were admitted to 4 LTACHs; 217 of 2,144 KPC-negative patients (10.1%) acquired KPC. In total, 100 of these patients were selected at random and matched to 100 controls by LTACH facility, admission date, and censored length of stay. Acquisitions occurred a median of 16.5 days after admission. On multivariate analysis, we found that exposure to higher colonization pressure (OR, 1.02; 95% CI, 1.01-1.04; P=.002), exposure to a carbapenem (OR, 2.25; 95% CI, 1.06-4.77; P=.04), and higher Charlson comorbidity index (OR, 1.14; 95% CI, 1.01-1.29; P=.04) were independent risk factors for KPC acquisition; the odds of KPC acquisition increased by 2% for each 1% increase in colonization pressure. CONCLUSIONS Higher colonization pressure, exposure to carbapenems, and a higher Charlson comorbidity index independently increased the odds of KPC acquisition among LTACH patients. Reducing colonization pressure (through separation of KPC-positive patients from KPC-negative patients using strict cohorts or private rooms) and reducing carbapenem exposure may prevent KPC cross transmission in this high-risk patient population. Infect Control Hosp Epidemiol 2017;38:670-677.
authors.affiliation: 1Department of Internal Medicine,Division of Infectious Diseases,Rush University Medical Center,Chicago,Illinois,United States.
authors.forename: Koh
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: 1Department of Internal Medicine,Division of Infectious Diseases,Rush University Medical Center,Chicago,Illinois,United States.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Lin
authors.affiliation: 2Julius Center for Health Sciences and Primary Care,University Medical Center Utrecht,Utrecht,Netherlands.
authors.forename: Manon
authors.initials: M
authors.lastname: Haverkate
authors.affiliation: 3Department of Pathology,Rush University Medical Center,Chicago,Illinois,United States.
authors.forename: Karen
authors.initials: K
authors.lastname: Lolans
authors.affiliation: 3Department of Pathology,Rush University Medical Center,Chicago,Illinois,United States.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Moore
authors.affiliation: 1Department of Internal Medicine,Division of Infectious Diseases,Rush University Medical Center,Chicago,Illinois,United States.
authors.forename: Shayna
authors.initials: S
authors.lastname: Weiner
authors.affiliation: 5Department of Medicine,Division of Infectious Diseases,Cook County Health and Hospitals System,Chicago,Illinois,United States.
authors.forename: Rosie D
authors.initials: RD
authors.lastname: Lyles
authors.affiliation: 1Department of Internal Medicine,Division of Infectious Diseases,Rush University Medical Center,Chicago,Illinois,United States.
authors.forename: Donald
authors.initials: D
authors.lastname: Blom
authors.affiliation: 1Department of Internal Medicine,Division of Infectious Diseases,Rush University Medical Center,Chicago,Illinois,United States.
authors.forename: Yoona
authors.initials: Y
authors.lastname: Rhee
authors.affiliation: 1Department of Internal Medicine,Division of Infectious Diseases,Rush University Medical Center,Chicago,Illinois,United States.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kemble
authors.affiliation: 6Department of Nursing,Rush University Medical Center,Chicago,Illinois,United States.
authors.forename: Louis
authors.initials: L
authors.lastname: Fogg
authors.affiliation: 7Metro Infectious Disease Consultants,LLC,Burr Ridge,Illinois,United States.
authors.forename: David W
authors.initials: DW
authors.lastname: Hines
authors.affiliation: 1Department of Internal Medicine,Division of Infectious Diseases,Rush University Medical Center,Chicago,Illinois,United States.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
authors.affiliation: 1Department of Internal Medicine,Division of Infectious Diseases,Rush University Medical Center,Chicago,Illinois,United States.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hayden
mesh_terms: D000368:Aged; D001426:Bacterial Proteins / Q000378:metabolism*; D015780:Carbapenems / Q000627:therapeutic use; D016022:Case-Control Studies; D015897:Comorbidity; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission*; D005260:Female; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission*; D007711:Klebsiella pneumoniae / Q000201:enzymology*; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012007:Rectum / Q000382:microbiology; D012307:Risk Factors; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase