Transfer from high-acuity long-term care facilities is associated with carriage of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae: a multihospital study

• Published in: Infection control and hospital epidemiology Vol. 33; no. 12; p. 1193
• Main Authors: Prabaker, Kavitha, Lin, Michael Y, McNally, Margaret, Cherabuddi, Kartikeya, Ahmed, Sana, Norris, Andrea, Lolans, Karen, Odeh, Ruba, Chundi, Vishnu, Weinstein, Robert A, Hayden, Mary K
• Format: Journal Article
• Language: English
• Published: United States 01.12.2012
• Subjects: Aged; Aged, 80 and over; Bacterial Proteins - biosynthesis; beta-Lactamases - biosynthesis; Carbapenems; Carrier State - diagnosis; Carrier State - epidemiology; Carrier State - microbiology; Case-Control Studies; Chicago - epidemiology; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Confidence Intervals; Cross Infection - epidemiology; Cross Infection - microbiology; Drug Resistance, Bacterial; Escherichia coli - enzymology; Escherichia coli Infections - epidemiology; Escherichia coli Infections - microbiology; Female; Humans; Klebsiella Infections - diagnosis; Klebsiella Infections - epidemiology; Klebsiella Infections - microbiology; Klebsiella pneumoniae - enzymology; Male; Middle Aged; Multilocus Sequence Typing; Odds Ratio; Prevalence; Propensity Score; Rectum - microbiology; Respiration, Artificial; Skilled Nursing Facilities - classification; Chicago
• ISSN: 1559-6834
• DOI: 10.1086/668435

To determine whether transfer from a long-term care facility (LTCF) is a risk factor for colonization with Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae upon acute care hospital admission. Microbiologic survey and nested case-control study. Four hospitals in a metropolitan area (Chicago) with an early KPC epidemic. Hospitalized adults. Patients transferred from LTCFs were matched 1∶1 to patients admitted from the community by age (± 10 years), admitting clinical service, and admission date (± 2 weeks). Rectal swab specimens were collected within 3 days after admission and tested for KPC-producing Enterobacteriaceae. Demographic and clinical information was extracted from medical records. One hundred eighty patients from LTCFs were matched to 180 community patients. KPC-producing Enterobacteriaceae colonization was detected in 15 (8.3%) of the LTCF patients and 0 (0%) of the community patients ([Formula: see text]). Prevalence of carriage differed by LTCF subtype: 2 of 135 (1.5%) patients from skilled nursing facilities without ventilator care (SNFs) were colonized upon admission, compared to 9 of 33 (27.3%) patients from skilled nursing facilities with ventilator care (VSNFs) and 4 of 12 (33.3%) patients from long-term acute care hospitals (LTACHs; [Formula: see text]). In a multivariable logistic regression model adjusted for a propensity score that predicted LTCF subtype, patients admitted from VSNFs or LTACHs had 7.0-fold greater odds of colonization (ie, odds ratio; 95% confidence interval, 1.3-42; [Formula: see text]) with KPC-producing Enterobacteriaceae than patients from an SNF. Patients admitted to acute care hospitals from high-acuity LTCFs (ie, VSNFs and LTACHs) were more likely to be colonized with KPC-producing Enterobacteriaceae than were patients admitted from the community. Identification of healthcare facilities with a high prevalence of colonized patients presents an opportunity for focused interventions that may aid regional control efforts.