scholarly journals Carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae across a hospital system: impact of post-acute care facilities on dissemination

2010 ◽  
Vol 65 (8) ◽  
pp. 1807-1818 ◽  
Author(s):  
F. Perez ◽  
A. Endimiani ◽  
A. J. Ray ◽  
B. K. Decker ◽  
C. J. Wallace ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acinetobacter Baumannii ◽  
Acute Care ◽  
Hospital System ◽  
Carbapenem Resistant ◽  
Care Facilities ◽  
Acute Care Facilities ◽  
System Impact ◽  
Post Acute Care

scholarly journals Regional spread of blaNDM-1-containing Klebsiella pneumoniae Sequence Type 147 in post-acute care facilities

2021 ◽  
Author(s):  
Zena Lapp ◽  
Ryan Crawford ◽  
Arianna Miles-Jay ◽  
Ali Pirani ◽  
William E Trick ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Patient Transfer ◽  
Point Prevalence ◽  
Care Hospital ◽  
Chicago Area ◽  
Care Facilities ◽  
Acute Care Facilities ◽  
Post Acute Care

Background Carbapenem-resistant Enterobacterales (CRE) harboring blaKPC have been endemic in Chicago-area healthcare networks for more than a decade. During 2016-2019, a series of regional point prevalence surveys identified increasing prevalence of blaNDM-containing CRE in multiple long-term acute care hospitals (LTACHs) and ventilator-capable skilled nursing facilities (vSNFs). We performed a genomic epidemiology investigation of blaNDM-producing CRE to understand their regional emergence and spread. Methods We performed whole-genome sequencing on NDM+ CRE isolates from four point-prevalence surveys across 35 facilities (LTACHs, vSNFs, and acute care hospital medical intensive care units) in the Chicago area and investigated the genomic relatedness and transmission dynamics of these isolates over time. Results Genomic analyses revealed that the rise of NDM+ CRE was due to the clonal dissemination of an ST147 Klebsiella pneumoniae strain harboring blaNDM-1 on an IncF plasmid. Dated phylogenetic reconstructions indicated that ST147 was introduced into the region around 2013 and likely acquired NDM around 2015. Analyzing genomic data in the context of patient transfer networks supported initial increases in prevalence due to intra-facility transmission in certain vSNFs, with evidence of subsequent inter-facility spread to connected LTACHs and vSNFs via patient transfer. Conclusions We identified a regional outbreak of blaNDM-1 ST147 that began in and disseminated across Chicago area post-acute care facilities. Our findings highlight the importance of performing genomic surveillance at post-acute care facilities to identify emerging threats.

scholarly journals 704. Klebsiella pneumoniae Carbapenemase and Verona Integron-Encoded Metallo-β-Lactamase Among Carbapenem-Resistant Enterobacteriaceae in Kentucky

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S253-S254
Author(s):  
Kevin Spicer ◽  
Lynn Roser ◽  
Andrea Flinchum
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Urban Areas ◽  
Demographic Data ◽  
Healthcare Facilities ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Care Facilities ◽  
Acute Care Facilities ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Klebsiella pneumoniae carbapenemase (KPC) and Verona integron-encoded metallo-β-lactamase (VIM) have been the most commonly identified carbapenemases among carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) in Kentucky since 2013. Understanding the frequency and epidemiology of these CP-CRE can help inform prevention strategies. Methods We reviewed reports of KPC- and VIM-producing CRE from January 2013 through December 2017. CRE became reportable in Kentucky in February 2015 and statewide request to laboratories and healthcare facilities for isolate submission for mechanism testing was made in September 2017. Prior to that time, mechanism testing for CRE was conducted at a limited number of laboratories or during outbreak investigations. Demographic data included age, sex, and inpatient or outpatient status. Descriptive analyses were performed. Results As of December 31, 2017, a total of 156 CP-CRE isolates had been identified (124 KPC, 31 VIM, 1 NDM), with an increase from 2013 (n = 13) to 2017 (n = 48). KPC was identified in isolates from 124 patients; VIM was identified in isolates from 26 patients, with 4 patients (15%) having multiple organisms with the mechanism. KPC was identified most commonly from Klebsiella pneumoniae (57/124, 46%); VIM was identified most commonly from Enterobacter cloacae (14/31, 45%). KPC was found in 6 different Enterobacteriaceae genera; VIM in 4. KPC-producing CRE were identified in 22 acute-care and long-term acute-care facilities in 14 counties, with nine reporting >2 isolates. Fifteen percent (19/124) of KPC-producing CRE were isolated from outpatients. VIM-producing CRE were identified in two acute-care facilities located in two urban areas; one was from an outpatient. Patients with VIM were younger than those with KPC (43 vs. 60 years, P < 0.001). Conclusion KPC is the predominant carbapenemase in Kentucky and is more widely disseminated than VIM, which has been limited to two facilities. CRE reporting and mechanism testing have yielded a greater understanding of regional CRE epidemiology and has the potential to facilitate response efforts to slow further spread. Disclosures All authors: No reported disclosures.

Factors Associated With Early Readmission Among Patients Discharged to Post-Acute Care Facilities

2017 ◽  
Vol 65 (6) ◽  
pp. 1199-1205 ◽  
Author(s):  
Carolyn Horney ◽  
Roberta Capp ◽  
Rebecca Boxer ◽  
Robert E. Burke
Keyword(s):  
Acute Care ◽  
Factors Associated ◽  
Care Facilities ◽  
Early Readmission ◽  
Acute Care Facilities ◽  
Post Acute Care

Pre-operative Predictors for Discharge to Post-Acute Care Facilities After Total Knee Arthroplasty

2021 ◽  
Author(s):  
Chan Zeng ◽  
Ryan Koonce ◽  
Heather M. Tavel ◽  
Suzanne Espiritu Argosino ◽  
Denise A. Kiepe ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Acute Care ◽  
Knee Arthroplasty ◽  
Care Facilities ◽  
Total Knee ◽  
Acute Care Facilities ◽  
Post Acute Care

The “Permanent” Patient Problem

2014 ◽  
Vol 42 (1) ◽  
pp. 88-92 ◽  
Author(s):  
Courtenay R. Bruce ◽  
Mary A. Majumder
Keyword(s):  
Health Care ◽  
Hospital Discharge ◽  
Acute Care ◽  
Affordable Care Act ◽  
Financial Incentive ◽  
Legal Obligation ◽  
Medicaid Enrollment ◽  
Care Facilities ◽  
Acute Care Facilities ◽  
Post Acute Care

Patients who enter the health care system for acute care may become “permanent” patients of the hospital when a lack of resources precludes discharge to the next level of post-acute care. The care of these patients contributes to the rising costs of health care and will remain largely unaffected by the Affordable Care Act. For example, some resources may be available for treatment of undocumented persons, but Medicaid enrollment is unavailable for this population. Even where patients have access to Medicaid, it takes up to three months between applying for and actually receiving Medicaid benefits. During that time, patients may be ready for hospital discharge. However, post-acute care facilities have no financial incentive or legal obligation to accept patients with no insurance or only pending Medicaid coverage.

Establishment of a Statewide Network for Carbapenem-Resistant Enterobacteriaceae Prevention in a Low-Incidence Region

2014 ◽  
Vol 35 (4) ◽  
pp. 356-361 ◽  
Author(s):  
Christopher D. Pfeiffer ◽  
Margaret C. Cunningham ◽  
Tasha Poissant ◽  
Jon P. Furuno ◽  
John M. Townes ◽  
...  
Keyword(s):  
Acute Care ◽  
Infection Prevention ◽  
Long Term Care ◽  
Term Care ◽  
Carbapenem Resistant ◽  
Care Facilities ◽  
Low Incidence ◽  
Acute Care Facilities ◽  
Carbapenem Resistant Enterobacteriaceae

Objective.To establish a statewide network to detect, control, and prevent the spread of carbapenem-resistant Enterobacteriaceae (CRE) in a region with a low incidence of CRE infection.Design.Implementation of the Drug Resistant Organism Prevention and Coordinated Regional Epidemiology (DROP-CRE) Network.Setting and Participants.Oregon infection prevention and microbiology laboratory personnel, including 48 microbiology laboratories, 62 acute care facilities, and 140 long-term care facilities.Methods.The DROP-CRE working group, comprising representatives from academic institutions and public health, convened an interdisciplinary advisory committee to assist with planning and implementation of CRE epidemiology and control efforts. The working group established a statewide CRE definition and surveillance plan; increased the state laboratory capacity to perform the modified Hodge test and polymerase chain reaction for carbapenemases in real time; and administered surveys that assessed the needs and capabilities of Oregon infection prevention and laboratory personnel. Results of these inquiries informed CRE education and the response plan.Results.Of 60 CRE reported from November 2010 through April 2013, only 3 were identified as carbapenemase producers; the cases were not linked, and no secondary transmission was found. Microbiology laboratories, acute care facilities, and long-term care facilities reported lacking carbapenemase testing capability, reliable interfacility communication, and CRE awareness, respectively. Survey findings informed the creation of the Oregon CRE Toolkit, a state-specific CRE guide booklet.Conclusions.A regional epidemiology surveillance and response network has been implemented in Oregon in advance of widespread CRE transmission. Prospective surveillance will determine whether this collaborative approach will be successful at forestalling the emergence of this important healthcare-associated pathogen.

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