Imipenemase-producing carbapenem-resistant Enterobacteriaceae transmission in a long-term-care facility during a community-wide multidrug resistant organism outbreak—North Carolina, 2017

AbstractPneumonia is a common infection among residents of long-term-care facilities (LTCFs), with an incidence of 1.2 episodes per 1,000 patient-days. This rate is believed to be six- to tenfold higher than the rate of pneumonia among elderly individuals living in the community. The risk factors for pneumonia among residents of LTCFs are profound disability, bedridden state, urinary incontinence, difficulty swallowing, malnutrition, tube feedings, contractures, and use of benzodiazepines and anticholinergic medications. An elevated respiratory rate is often an early clue to pneumonia in this group of patients. Staphylococcus aureus (including methicillin-resistant S. aureus) and aerobic gram-negative bacilli (including multidrug-resistant isolates) are more frequent causes of pneumonia in this setting than in the community. Criteria have been developed that help identify patients for treatment in their LTCFs.

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Multidrug-ResistantAcinetobacter baumanniiInfection, Colonization, and Transmission Related to a Long-Term Care Facility Providing Subacute Care

Infection Control and Hospital Epidemiology ◽

10.1086/675612 ◽

2014 ◽

Vol 35 (4) ◽

pp. 406-411 ◽

Cited By ~ 17

Author(s):

Eva Mortensen ◽

Kavita K. Trivedi ◽

Jon Rosenberg ◽

Sara H. Cody ◽

Janet Long ◽

...

Keyword(s):

Long Term Care ◽

Care Facility ◽

Multidrug Resistant ◽

Term Care ◽

Term Care Facility ◽

Long Term Care Facility ◽

Subacute Care ◽

Hospital Patients ◽

Resistance Patterns

Objective.To investigateAcinetobacter baumanniiinfection, colonization, and transmission related to a long-term care facility (LTCF) providing subacute care (facility A).Methods.We reviewed facility A and affiliated local hospital records for facility A residents withA. baumanniiisolated during the period January 2009 through February 2010 and comparedA. baumanniiantimicrobial resistance patterns of residents with those of hospital patients. During March 2010, we implemented a colonization survey of facility A residents who received respiratory support or who could provide sputum samples and looked forA. baumanniicolonization risks. Available clinical and survey isolates underwent pulsed-field gel electrophoresis (PFGE); PFGE strains were linked with overlapping stays to identify possible transmission.Results.During the period January 2009 through February 2010, 33 facility A residents hadA. baumanniiisolates; all strains were multidrug resistant (MDR), which was a significantly higher prevalence of MDR strains than that found among isolates from hospital patients (81 [66%] of 122 hospital patient isolates were MDR;P< .001). The sputum survey found that 14 (20%) of 70 residents hadA. baumanniicolonization, which was associated with ventilator use (adjusted odds ratio, 4.24 [95% confidence interval, 1.06–16.93]); 12 (86%) of 14 isolates were MDR. Four facility A resident groups clustered with 3 PFGE strains and overlapping stays. One of these facility A residents also clustered with 3 patients at an affiliated hospital.Conclusions.We documented substantial MDRA. baumanniiinfections and colonization with probable intra- and interfacility spread associated with a single LTCF providing subacute care. Given the limited infection prevention and antimicrobial stewardship resources in such settings, regional collaborations among facilities across the spectrum of health care are needed to address this MDR threat.

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Evaluation of Remel Spectra CRE Agar for Detection of Carbapenem-Resistant Bacteria from Rectal Swabs Obtained from Residents of a Long-Term-Care Facility

Journal of Clinical Microbiology ◽

10.1128/jcm.00789-15 ◽

2015 ◽

Vol 53 (9) ◽

pp. 2823-2826 ◽

Cited By ~ 7

Author(s):

Vincent J. LaBombardi ◽

Carl M. Urban ◽

Barry N. Kreiswirth ◽

Liang Chen ◽

Giuliana Osorio ◽

...

Keyword(s):

Long Term Care ◽

Agar Plate ◽

Care Facility ◽

Resistant Bacteria ◽

Term Care ◽

Content Type ◽

Term Care Facility ◽

Long Term Care Facility ◽

Carbapenem Resistant

We compared the Remel Spectra CRE agar plate to CDC standard methodology for the isolation of carbapenem-resistantEnterobacteriaceae(CRE) from 300 rectal swab specimens obtained from patients residing in a long-term-care facility (LTCF). Multiplex PCR experiments were performed on isolates to identify specificKlebsiella pneumoniaecarbapenemases (KPC) and additional β-lactamases. Of the 300 patients, 72 (24%) harbored CRE and were PCR positive for KPC enzymes. The Remel Spectra CRE plates detected KPC-type CRE in isolates from 70 of 72 patients (97.2%), while the CDC method detected CRE in 56 of 72 (77.8%). CRE identification results were available in 18 h compared to 36 h for the CDC method. Remel Spectra CRE agar plates can provide useful means for a fast and reliable method for detecting KPC-type CRE and for accelerated institution of appropriate infection control precautions.

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