Faculty Collaboration Database

Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2011 Sep;53(6):532-40

Date

08/26/2011

Pubmed ID

21865189

DOI

10.1093/cid/cir482

Scopus ID

2-s2.0-80052247996 (requires institutional sign-in at Scopus site)   206 Citations

Abstract

UNLABELLED: Exposure network analysis and molecular epidemiologic methods were used to analyze the emergence and regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae over a 1-year period. Although 40 patients and 26 health care facilities were affected, 1 long-term acute care hospital played a critical role in the convergence of patients at high risk, amplification by cross-infection, and dissemination of these multidrug-resistant bacteria.

BACKGROUND: Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae are an emerging antibiotic resistance threat with demonstrated epidemic potential.

METHODS: We conducted an outbreak investigation of KPC-producing Enterobacteriaceae among patients of acute and long-term acute care hospitals (LTACHs) in 4 adjacent counties in Indiana and Illinois from 1 January 2008 through 31 December 2008 (cases). The study used traditional and molecular epidemiologic methods and an adaptation of social network analysis ("exposure network analysis").

RESULTS: Clinical records for 40 (95%) of 42 patients were available. Patients were mostly older with multiple comorbid conditions. Eleven patients (27.5%) died during the index hospitalization or were discharged to hospice; 23 (57.5%) were discharged to a nursing home, and 4 (10.0%) were discharged to home. One LTACH (LTACH-A) was central to the regional outbreak: 24 (60%) of 40 cases were linked to LTACH-A, and at least 10 patients (25%) acquired KPC there. Of 16 cases not linked to LTACH-A, 12 (75%) were linked to 3 nursing homes. Only 4 patients (10%) definitely acquired KPC during an acute care hospital stay. Molecular typing revealed the 31 available KPC-positive K. pneumoniae isolates to be similar and to cluster with epidemic multilocus sequence type 258; 2 KPC-positive Escherichia coli isolates were unique.

CONCLUSIONS: We observed extensive transfer of KPC-positive patients throughout the exposure network of 14 acute care hospitals, 2 LTACHs, and 10 nursing homes. Although few cases were identified at most institutions, many facilities were affected. Successful control of KPC-producing Enterobacteriaceae will require a coordinated, regional effort among acute and long-term health care facilities and public health departments.

Author List

Won SY, Munoz-Price LS, Lolans K, Hota B, Weinstein RA, Hayden MK, Centers for Disease Control and Prevention Epicenter Program

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Bacterial Proteins
Bacterial Typing Techniques
Contact Tracing
Cross Infection
Disease Outbreaks
Drug Resistance, Multiple, Bacterial
Female
Humans
Illinois
Indiana
Klebsiella Infections
Klebsiella pneumoniae
Male
Middle Aged
Molecular Epidemiology
Multilocus Sequence Typing
beta-Lactamases