Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct 3;5(10):ofy224.
doi: 10.1093/ofid/ofy224. eCollection 2018 Oct.

Epidemiology of Carbapenem-Resistant Enterobacteriaceae at a Long-term Acute Care Hospital

Teena Chopra  1 , Christopher Rivard  1 , Reda A Awali  1 , Amar Krishna  1 , Robert A Bonomo  2 , Federico Perez  2 , Keith S Kaye  1
Affiliations

Epidemiology of Carbapenem-Resistant Enterobacteriaceae at a Long-term Acute Care Hospital

Teena Chopra et al. Open Forum Infect Dis. .

Abstract

Background: Residents of long-term acute care hospitals (LTACHs) are considered important reservoirs of multidrug-resistant organisms, including Carbapenem-resistant Enterobacteriaceae (CRE). We conducted this study to define the characteristics of CRE-infected/colonized patients admitted to an LTACH and the molecular characteristics of the CRE isolates.

Methods: This retrospective study was conducted to collect information on demographic and comorbid conditions in CRE-colonized/infected patients admitted to a 77-bed LTACH in Detroit between January 2011 and July 2012. Data pertaining to hospital-related exposures were collected for 30 days before positive CRE culture. Polymerase chain reaction (PCR) gene amplification, repetitive sequence-based PCR, and multilocus sequence typing (MLST) were performed on 8 of the CRE isolates.

Results: The study cohort included 30 patients with CRE-positive cultures, 24 (80%) with infections, and 6 (20%) with colonization. The mean age of cohort was 69 ±12.41 years; 19 (63%) patients were ventilator-dependent, and 20 (67%) were treated with at least 1 antibiotic. Twenty-three (77%) patients had CRE detected following LTACH admission, and the median days from admission to CRE detection in these patients (interquartile range) was 25 (11-43). Seven more patients were already positive for CRE at the time of LTACH admission. Molecular genotyping and MLST of 8 CRE isolates demonstrated that all isolates belonged to the same strain type (ST258) and contained the bla KPC-3 sequence.

Conclusions: The majority of patients with CRE presented several days to weeks after LTACH admission, indicating possible organism acquisition in the LTACH itself. The genetic similarity of the CRE isolates tested could further indicate the occurrence of horizontal transmission in the LTACH or simply be representative of the regionally dominant strain.

Keywords: Klebsiella pneumoniae Carbapenemase (KPC); horizontal transmission; multilocus sequence typing; repetitive sequence–based PCR.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Distribution of colonization and infection among the various sources of CRE isolates. Abbreviations: CRE, Carbapenem-resistant Enterobacteriaceae; KPC, Klebsiella pneumoniae Carbapenemase.
Figure 2.
Figure 2.
Time to culture positivity in patients developing CRE infection/colonization following LTACH admission. Abbreviations: CRE, Carbapenem-resistant Enterobacteriaceae; LTACH, long-term acute care hospital.
Figure 3.
Figure 3.
Distribution of CRE isolates during the study period. Checkered rectangles indicate CRE isolates detected after LTACH admission which underwent molecular genotyping. Abbreviations: CRE, Carbapenem-resistant Enterobacteriaceae; LTACH, long-term acute care hospital.
Figure 4.
Figure 4.
Molecular genotyping using repetitive sequence–based polymerase chain reaction of 8 Carbapenem-resistant Enterobacteriaceae isolates.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae Carbapenemase-producing bacteria. Lancet Infect Dis 2009; 9:228–36. - PubMed
    1. Chitnis AS, Caruthers PS, Rao AK, et al. . Outbreak of Carbapenem-resistant Enterobacteriaceae at a long-term acute care hospital: sustained reductions in transmission through active surveillance and targeted interventions. Infect Control Hosp Epidemiol 2012; 33:984–92. - PubMed
    1. Lübbert C, Becker-Rux D, Rodloff AC, et al. . Colonization of liver transplant recipients with KPC-producing Klebsiella pneumoniae is associated with high infection rates and excess mortality: a case-control analysis. Infection 2014; 42:309–16. - PubMed
    1. Zasowski EJ, Rybak JM, Rybak MJ. The β-lactams strike back: ceftazidime-avibactam. Pharmacotherapy 2015; 35:755–70. - PMC - PubMed
    1. Lim LM, Ly N, Anderson D, et al. . Resurgence of colistin: a review of resistance, toxicity, pharmacodynamics, and dosing. Pharmacotherapy 2010; 30:1279–91. - PMC - PubMed