Open AccessModifiable Risk Factors for the Spread of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae Among Long-Term Acute-Care Hospital Patients
Author(s) -
Koh Okamoto,
Michael Lin,
Ma Haverkate,
Karen Lolans,
Natalie Moore,
Shayna Weiner,
Rosie D. Lyles,
Donald Blom,
Yoona Rhee,
Sarah K. Kemble,
Louis Fogg,
David Hines,
Robert A. Weinstein,
Mary K. Hayden
Publication year - 2017
Publication title -
infection control and hospital epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.243
H-Index - 138
eISSN - 1559-6834
pISSN - 0899-823X
DOI - 10.1017/ice.2017.62
Subject(s) - medicine , klebsiella pneumoniae , odds ratio , comorbidity , acute care , infection control , colonization , carbapenem resistant enterobacteriaceae , multivariate analysis , emergency medicine , intensive care medicine , microbiology and biotechnology , health care , biology , biochemistry , escherichia coli , economics , gene , economic growth
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.