scholarly journals Cohorting KPC+ Klebsiella pneumoniae (KPC-Kp)–positive patients: A genomic exposé of cross-colonization hazards in a long-term acute-care hospital (LTACH)

2020 ◽  
Vol 41 (10) ◽  
pp. 1162-1168
Author(s):  
Shawn E. Hawken ◽  
Mary K. Hayden ◽  
Karen Lolans ◽  
Rachel D. Yelin ◽  
Robert A. Weinstein ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Resistance Genes ◽  
Acute Care Hospital ◽  
Antibiotic Resistance Genes ◽  
Care Hospital ◽  
Cross Transmission ◽  
The Impact

AbstractObjective:Cohorting patients who are colonized or infected with multidrug-resistant organisms (MDROs) protects uncolonized patients from acquiring MDROs in healthcare settings. The potential for cross transmission within the cohort and the possibility of colonized patients acquiring secondary isolates with additional antibiotic resistance traits is often neglected. We searched for evidence of cross transmission of KPC+ Klebsiella pneumoniae (KPC-Kp) colonization among cohorted patients in a long-term acute-care hospital (LTACH), and we evaluated the impact of secondary acquisitions on resistance potential.Design:Genomic epidemiological investigation.Setting:A high-prevalence LTACH during a bundled intervention that included cohorting KPC-Kp–positive patients.Methods:Whole-genome sequencing (WGS) and location data were analyzed to identify potential cases of cross transmission between cohorted patients.Results:Secondary KPC-Kp isolates from 19 of 28 admission-positive patients were more closely related to another patient’s isolate than to their own admission isolate. Of these 19 cases, 14 showed strong genomic evidence for cross transmission (<10 single nucleotide variants or SNVs), and most of these patients occupied shared cohort floors (12 patients) or rooms (4 patients) at the same time. Of the 14 patients with strong genomic evidence of acquisition, 12 acquired antibiotic resistance genes not found in their primary isolates.Conclusions:Acquisition of secondary KPC-Kp isolates carrying distinct antibiotic resistance genes was detected in nearly half of cohorted patients. These results highlight the importance of healthcare provider adherence to infection prevention protocols within cohort locations, and they indicate the need for future studies to assess whether multiple-strain acquisition increases risk of adverse patient outcomes.

scholarly journals Cohorting KPC+ Klebsiella pneumoniae (KPC-Kp) positive patients – a genomic exposé of cross-colonization hazards in a long-term acute care hospital (LTACH)

2020 ◽  
Author(s):  
Shawn E. Hawken ◽  
Mary K. Hayden ◽  
Karen Lolans ◽  
Rachel D. Yelin ◽  
Robert A. Weinstein ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Resistance Genes ◽  
Acute Care Hospital ◽  
Antibiotic Resistance Genes ◽  
Care Hospital ◽  
Cross Transmission ◽  
The Impact

AbstractObjectiveCohorting patients who are colonized or infected with multidrug-resistant organisms (MDROs) has been demonstrated to protect uncolonized patients from acquiring MDROs in healthcare settings. A neglected aspect of cohorting is the potential for cross-transmission within the cohort and the possibility of colonized patients acquiring secondary isolates with additional antibiotic resistance traits. We searched for evidence of cross-transmission of KPC+ Klebsiella pneumoniae (KPC-Kp) colonization among cohorted patients in a long-term acute care hospital (LTACH), and evaluated the impact of secondary acquisitions on resistance potential.DesignGenomic epidemiological investigationSettingA high-prevalence LTACH during a bundled intervention that included cohorting KPC-Kp-positive patients.MethodsWhole-genome sequencing (WGS) and location data were analyzed to identify potential cases of cross-transmission between cohorted patients.ResultsSecondary KPC-Kp isolates from 19 of 28 admission-positive patients were more closely related to another patient’s isolate than to their own admission isolate. In 14 of these 19 cases there was strong genomic evidence for cross-transmission (<10 SNVs) and the majority of these patients occupied shared cohort floors (12 cases) or rooms (5 cases) at the same time. Of the 14 patients with strong genomic evidence of acquisition, 12 acquired antibiotic resistance genes not found in their primary isolates.ConclusionsAcquisition of secondary KPC-Kp isolates carrying distinct antibiotic resistance genes was detected in nearly half of cohorted patients. These results highlight the importance of healthcare provider adherence to infection prevention protocols within cohort locations, and motivate future studies to assess whether multiple-strain acquisition increases risk of adverse patient outcomes.

scholarly journals Emergence of blaKPC-containing Klebsiella pneumoniae in a long-term acute care hospital: a new challenge to our healthcare system

2009 ◽  
Vol 64 (5) ◽  
pp. 1102-1110 ◽  
Author(s):  
A. Endimiani ◽  
J. M. DePasquale ◽  
S. Forero ◽  
F. Perez ◽  
A. M. Hujer ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Healthcare System ◽  
Acute Care Hospital ◽  
Care Hospital

scholarly journals Modifiable Risk Factors for the Spread of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae Among Long-Term Acute-Care Hospital Patients

2017 ◽  
Vol 38 (06) ◽  
pp. 670-677 ◽  
Author(s):  
Koh Okamoto ◽  
Michael Y. Lin ◽  
Manon Haverkate ◽  
Karen Lolans ◽  
Nicholas M. Moore ◽  
...  
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Modifiable Risk Factors ◽  
Surveillance Culture ◽  
Care Hospital ◽  
Colonization Pressure ◽  
Comorbidity Index

OBJECTIVETo identify modifiable risk factors for acquisition ofKlebsiella pneumoniaecarbapenemase-producing Enterobacteriaceae (KPC) colonization among long-term acute-care hospital (LTACH) patients.DESIGNMulticenter, matched case-control study.SETTINGFour LTACHs in Chicago, Illinois.PARTICIPANTSEach 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.RESULTSFrom 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.CONCLUSIONSHigher 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 Epidemiol2017;38:670–677

Risk of Acquiring Carpapenem-resistant Klebsiella Pneumoniae from Bed Contact in a Long-term Acute Care Hospital

2014 ◽  
Vol 42 (6) ◽  
pp. S30-S31 ◽  
Author(s):  
Robert Kelley ◽  
Timothy Wiemken ◽  
Daniel Curran ◽  
Mohammad Khan ◽  
Emily Pacholski ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital

scholarly journals The Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Colonization and Infection among Long-Term Acute Care Hospital Residents

2015 ◽  
Vol 37 (1) ◽  
pp. 55-60 ◽  
Author(s):  
John P Mills ◽  
Naasha J Talati ◽  
Kevin Alby ◽  
Jennifer H Han
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Significant Risk ◽  
Acute Care Hospital ◽  
Carbapenem Resistance ◽  
Solid Organ ◽  
Care Hospital ◽  
Carbapenem Resistant

OBJECTIVEAn improved understanding of carbapenem-resistant Klebsiella pneumoniae (CRKP) in long-term acute care hospitals (LTACHs) is needed. The objective of this study was to assess risk factors for colonization or infection with CRKP in LTACH residents.METHODSA case-control study was performed at a university-affiliated LTACH from 2008 to 2013. Cases were defined as all patients with clinical cultures positive for CRKP and controls were those with clinical cultures positive for carbapenem-susceptible K. pneumoniae (CSKP). A multivariate model was developed to identify risk factors for CRKP infection or colonization.RESULTSA total of 222 patients were identified with K. pneumoniae clinical cultures during the study period; 99 (45%) were case patients and 123 (55%) were control patients. Our multivariate analysis identified factors associated with a significant risk for CRKP colonization or infection: solid organ or stem cell transplantation (OR, 5.05; 95% CI, 1.23–20.8; P=.03), mechanical ventilation (OR, 2.56; 95% CI, 1.24–5.28; P=.01), fecal incontinence (OR, 5.78; 95% CI, 1.52–22.0; P=.01), and exposure in the prior 30 days to meropenem (OR, 3.55; 95% CI, 1.04–12.1; P=.04), vancomycin (OR, 2.94; 95% CI, 1.18–7.32; P=.02), and metronidazole (OR, 4.22; 95% CI, 1.28–14.0; P=.02).CONCLUSIONSRates of colonization and infection with CRKP were high in the LTACH setting, with nearly half of K. pneumoniae cultures demonstrating carbapenem resistance. Further studies are needed on interventions to limit the emergence of CRKP in LTACHs, including targeted surveillance screening of high-risk patients and effective antibiotic stewardship measures.Infect. Control Hosp. Epidemiol. 2015;37(1):55–60

scholarly journals The Effectiveness of Routine Daily Chlorhexidine Gluconate Bathing in Reducing Klebsiella pneumoniae Carbapenemase–Producing Enterobacteriaceae Skin Burden among Long-Term Acute Care Hospital Patients

2014 ◽  
Vol 35 (4) ◽  
pp. 440-442 ◽  
Author(s):  
Michael Y. Lin ◽  
Karen Lolans ◽  
Donald W. Blom ◽  
Rosie D. Lyles ◽  
Shayna Weiner ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Chlorhexidine Gluconate ◽  
Care Hospital ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Hospital Patients ◽  
Skin Colonization

We evaluated the effectiveness of daily chlorhexidine gluconate (CHG) bathing in decreasing skin carriage of Klebsiella pneumoniae carbapenemase–producing Enterobacteriaceae (KPC) among long-term acute care hospital patients. CHG bathing reduced KPC skin colonization, particularly when CHG skin concentrations greater than or equal to 128 μg/mL were achieved.

scholarly journals A novel threshold-independent approach to genomic cluster analysis discloses persistent routes of KPC+ Klebsiella pneumoniae transmission in a long-term acute care hospital

2020 ◽  
Author(s):  
Shawn Emily Hawken ◽  
Rachel D Yelin ◽  
Karen Lolans ◽  
Robert A Weinstein ◽  
Michael Y Lin ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
False Negative ◽  
Acute Care Hospital ◽  
Patient Discharge ◽  
Epidemiological Data ◽  
Care Hospital ◽  
Single Nucleotide Variants ◽  
Transmission Pathways

Background Carbapenem-resistant Enterobacteriaceae have been recognized as an urgent antibiotic resistance threat for more than a decade. Despite this attention, their prevalence has remained steady or increased in some settings, suggesting that transmission pathways remain uncontrolled by current prevention strategies. We hypothesized that these transmission pathways, and hence targets for improved prevention, could be elucidated through comprehensive patient sampling, followed by integration of whole-genome sequencing (WGS) and epidemiological data. Methods Longitudinal KPC+ Klebsiella pneumoniae (KPC-Kp) surveillance cultures were collected from 94% of patients in a long-term acute care hospital (LTACH) during a one-year bundled intervention to reduce KPC-Kp prevalence. WGS of 462 KPC-Kp isolates from 256 patients, and associated surveillance data were integrated using a distance threshold-free approach to identify transmission clusters that grouped patients acquiring KPC-Kp in the LTACH with the admission-positive "index" patients that imported their strain into the facility. Plausible transmission pathways within clusters were identified using patient location data. Findings Transmission clusters (N=49) had between 2-14 patients, capturing KPC-Kp acquisitions from 100 (80%) patients who first acquired KPC-Kp in the LTACH. Within-cluster genetic diversity varied from 0-154 (median 9) single-nucleotide variants (SNVs), with elevated diversity being driven by prolonged asymptomatic colonization and evolution of hypermutator strains. Transmission between patients in clusters could be explained by spatiotemporal overlap in patient rooms (14%), wards (66%), or facility (81%). Sequential exposure to the same patient room was the only epidemiological link for one patient, indicating that residual environmental contamination of rooms after patient discharge contributed little to transmission. Persistent, modifiable routes of transmission were associated with lapses in patient cohorting, transmission between cohort and non-cohort locations and clusters propagating due to false-negative surveillance. Interpretation Integration of comprehensive surveillance and WGS data using a SNV threshold-free approach disclosed specific instances where improved patient and healthcare worker cohorting, reducing exposures to common locations outside of patient rooms, and improved KPC-Kp colonization detection could reduce transmission. Overall, results highlight the potential for WGS to monitor and improve infection prevention and the importance of combining rigorous sampling with appropriate analytical strategies to generate actionable hypotheses.

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