The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae

Abstract

Background: In the United States, Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae are increasingly detected in clinical infections; however, the colonization burden of these organisms among short-stay and long-term acute care hospitals is unknown.

Methods: Short-stay acute care hospitals with adult intensive care units (ICUs) in the city of Chicago were recruited for 2 cross-sectional single-day point prevalence surveys (survey 1, July 2010-January 2011; survey 2, January-July 2011). In addition, all long-term acute care hospitals (LTACHs) in the Chicago region (Cook County) were recruited for a single-day point prevalence survey during January-May 2011. Swab specimens were collected from rectal, inguinal, or urine sites and tested for Enterobacteriaceae carrying blaKPC.

Results: We surveyed 24 of 25 eligible short-stay acute care hospitals and 7 of 7 eligible LTACHs. Among LTACHs, 30.4% (119 of 391) of patients were colonized with KPC-producing Enterobacteriaceae, compared to 3.3% (30 of 910) of short-stay hospital ICU patients (prevalence ratio, 9.2; 95% confidence interval, 6.3-13.5). All surveyed LTACHs had patients harboring KPC (prevalence range, 10%-54%), versus 15 of 24 short-stay hospitals (prevalence range, 0%-29%). Several patient-level covariates present at the time of survey-LTACH facility type, mechanical ventilation, and length of stay-were independent risk factors for KPC-producing Enterobacteriaceae colonization.

Conclusions: We identified high colonization prevalence of KPC-producing Enterobacteriaceae among patients in LTACHs. Patients with chronic medical care needs in long-term care facilities may play an important role in the spread of these extremely drug-resistant pathogens.

Keywords: Klebsiella pneumoniae carbapenemase; carbapenem-resistant Enterobacteriaceae; healthcare epidemiology; intensive care units; long-term care facilities.

Figure 1.

Colonization prevalence of Klebsiella pneumoniae carbapenemase–producing Enterobacteriaceae among patients in short-stay acute care hospital intensive care units versus long-term acute care hospitals. Solid dots represent aggregate colonization rates, with error bars representing 95% confidence intervals. Each bubble represents a single facility, with bubble size proportional to the number of patients participating in the point prevalence surveys. Short-stay acute care hospitals were surveyed twice; results were aggregated into a single summary prevalence per facility for purpose of this figure. Abbreviations: ICU, intensive care unit; LTACH, long-term acute care hospital.