1261. Antimicrobial Susceptibilities of Carbapenem-Resistant Klebsiella pneumoniae (CRKP) Isolates from a Multi-state Network of Long-term Acute Care Hospitals (LTACHs)

Abstract Background CRKP infection is common among LTACH patients. However, CRKP antimicrobial susceptibility testing (AST) with newer antibiotics has not been described in this population. In this study, we performed AST on CRKP in LTACHs. Methods CRKP clinical cultures were collected from 21 Kindred Healthcare LTACHs (12 southern California, 6 Texas, 2 Florida, 1 Kentucky) from 8/1/14-7/25/15. AST was performed using a custom SensititreTM broth microdilution panel (ThermoFisher Scientific, Waltham, MA). 2021 Clinical & Laboratory Standards Institute interpretive criteria were used for all agents except plazomicin (PLZ), for which US Food and Drug Administration breakpoints were used. Results 459 CRKP clinical isolates were collected, including 254 (55.5%) respiratory, 155 (33.8%) urine, 39 (8.5%) blood, and 10 (2.2%) wound cultures. Most (419, 91.0%) were from southern California. 151 (32.9%) were colistin-resistant. 42 (9.2%) isolates were non-susceptible to meropenem-vaborbactam (MVB), 16 (8.9%) to imipenem-relebactam (IPR), 4 (0.9%) to ceftazidime-avibactam (CZA), and 3 (0.7%) to PLZ. Cross-resistance patterns are shown in Table 1. Among southern California facilities, there was significant inter-facility variation in MVB non-susceptibility (Pearson’s chi-squared test, p=0.005) but not in CZA, IPR, or PLZ non-susceptibility. Table 1. Cross-resistance to antimicrobials among carbapenem-resistant Klebsiella pneumoniae isolates from 21 Kindred long-term acute care facilities, August 1, 2014 – July 25, 2015 (N=459). Number of isolates and column percentages reported. 2021 Clinical & Laboratory Standards Institute interpretive criteria are used for all agents except for PLZ, for which US Food and Drug Administration breakpoints are used. Abbreviations: CST = colistin. CZA = ceftazidime-avibactam. I = intermediate. IPR = imipenem-relebactam. MIC = minimum inhibitory concentration. MVB = meropenem-vaborbactam. PLZ = plazomicin. R = resistant. S = susceptible. Conclusion In this sample of CRKP isolates from LTACHs in 2014-2015, nearly 10% of isolates were non-susceptible to MVB or IPR, respectively, despite neither agent being commercially available at the time. In contrast, there was a low prevalence of non-susceptibility to CZA, which received initial US Food and Drug Association approval in 2/2015, and PLZ, which was not commercially available during the study period. Cross-resistance between CZA and carbapenem/beta-lactamase combination antibiotics was uncommon. Future studies should evaluate CRKP susceptibilities to new agents in post-marketing cohorts and identify risk factors for resistance. Disclosures Jennifer Han, MD, MSCE, GlaxoSmithKline (Employee, Shareholder) Ebbing Lautenbach, MD, MPH, MSCE, Merck (Other Financial or Material Support, Member of Data and Safety Monitoring Board (DSMB))

Download Full-text

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

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkq191 ◽

2010 ◽

Vol 65 (8) ◽

pp. 1807-1818 ◽

Cited By ~ 127

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

Download Full-text

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.254 ◽

2015 ◽

Vol 37 (1) ◽

pp. 55-60 ◽

Cited By ~ 20

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

Download Full-text

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

Infection Control and Hospital Epidemiology ◽

10.1086/675605 ◽

2014 ◽

Vol 35 (4) ◽

pp. 356-361 ◽

Cited By ~ 15

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.

Download Full-text

Risk Factors for Colonization due to Carbapenem-Resistant Enterobacteriaceae among Patients: Exposed to Long-Term Acute Care and Acute Care Facilities

Infection Control and Hospital Epidemiology ◽

10.1086/675614 ◽

2014 ◽

Vol 35 (4) ◽

pp. 398-405 ◽

Cited By ~ 52

Author(s):

Ashish Bhargava ◽

Kayoko Hayakawa ◽

Ethan Silverman ◽

Samran Haider ◽

Krishna Chaitanya Alluri ◽

...

Keyword(s):

Risk Factors ◽

Hospital Admission ◽

Acute Care ◽

Entire Cohort ◽

Carbapenem Resistant ◽

Increased Risk ◽

Surveillance Programs ◽

Acute Care Facilities ◽

Carbapenem Resistant Enterobacteriaceae

Background.This study aimed to identify risk factors associated with carbapenem-resistant Enterobacteriaceae (CRE) colonization among patients screened with rectal cultures upon admission to a hospital or long-term acute care (LTAC) center and to compare risk factors among patients who were screen positive for CRE at the time of hospital admission with those screen positive prior to LTAC admission.Methods.A retrospective nested matched case-control study was conducted from June 2009 to December 2011. Patients with recent LTAC exposure were screened for CRE carriage at the time of hospital admission, and patients admitted to a regional LTAC facility were screened prior to LTAC admission. Cases were patients with a positive CRE screening culture, and controls (matched in a 3:1 ratio to cases) were patients with negative screening cultures.Results.Nine hundred five cultures were performed on 679 patients. Forty-eight (7.1%) cases were matched to 144 controls. One hundred fifty-eight patients were screened upon hospital admission and 521 prior to LTAC admission. Independent predictors for CRE colonization included Charlson's score greater than 3 (odds ratio [OR], 4.85 [95% confidence interval (CI), 1.64–14.41]), immunosuppression (OR, 3.92 [95% CI, 1.08–1.28]), presence of indwelling devices (OR, 5.21 [95% CI, 1.09–2.96]), and prior antimicrobial exposures (OR, 3.89 [95% CI, 0.71–21.47]). Risk factors among patients screened upon hospital admission were similar to the entire cohort. Among patients screened prior to LTAC admission, the characteristics of the CRE-colonized and noncolonized patients were similar.Conclusions.These results can be used to identify patients at increased risk for CRE colonization and to help target active surveillance programs in healthcare settings.

Download Full-text

Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae in a Network of Long-Term Acute Care Hospitals

Clinical Infectious Diseases ◽

10.1093/cid/ciw856 ◽

2016 ◽

pp. ciw856 ◽

Cited By ~ 8

Author(s):

Jennifer H. Han ◽

Ellie J.C. Goldstein ◽

Jacqueleen Wise ◽

Warren B. Bilker ◽

Pam Tolomeo ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Acute Care ◽

Acute Care Hospitals ◽

Carbapenem Resistant

Download Full-text

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.711 ◽

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.

Download Full-text

Carbapenem-Resistant Enterobacteriaceae Rectal Screening during an Outbreak of New Delhi Metallo-β-Lactamase–Producing Klebsiella pneumoniae at an Acute Care Hospital

Infection Control and Hospital Epidemiology ◽

10.1086/675597 ◽

2014 ◽

Vol 35 (4) ◽

pp. 434-436 ◽

Cited By ~ 14

Author(s):

Larissa M. Pisney ◽

M. A. Barron ◽

E. Kassner ◽

D. Havens ◽

N. E. Madinger

Keyword(s):

Klebsiella Pneumoniae ◽

Acute Care ◽

Teaching Hospital ◽

Tertiary Care ◽

Acute Care Hospital ◽

University Teaching ◽

New Delhi ◽

Care Hospital ◽

Carbapenem Resistant ◽

Carbapenem Resistant Enterobacteriaceae

We describe the results of carbapenem-resistant Enterobacteriaceae (CRE) screening as part of an outbreak investigation of New Delhi metallo-β-lactamase–producing CRE at a tertiary care university teaching hospital. The manual method for CRE screening was useful for detecting patients with asymptomatic CRE carriage but was time-consuming and costly.

Download Full-text

The impact of long-term acute-care facilities on the outcome and cost of care for patients undergoing prolonged mechanical ventilation

Critical Care Medicine ◽

10.1097/00003246-200002000-00009 ◽

2000 ◽

Vol 28 (2) ◽

pp. 342-350 ◽

Cited By ~ 79

Author(s):

Michael G. Seneff ◽

Doug Wagner ◽

Douglas Thompson ◽

Charlene Honeycutt ◽

Michael R. Silver

Keyword(s):

Mechanical Ventilation ◽

Acute Care ◽

Prolonged Mechanical Ventilation ◽

Cost Of Care ◽

Care Facilities ◽

Acute Care Facilities ◽

The Impact

Download Full-text

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.261 ◽

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.

Download Full-text