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

Infect Control Hosp Epidemiol. 2012 Dec;33(12):1193-9. doi: 10.1086/668435. Epub 2012 Oct 25.


Objective: 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.

Design: Microbiologic survey and nested case-control study.

Setting: Four hospitals in a metropolitan area (Chicago) with an early KPC epidemic.

Patients: Hospitalized adults.

Methods: 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.

Results: 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.

Conclusions: 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.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bacterial Proteins / 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
  • beta-Lactamases / biosynthesis*


  • Bacterial Proteins
  • Carbapenems
  • beta-Lactamases
  • carbapenemase