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

Abstract

Objective An 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. Methods A 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 multivariable model was developed to identify risk factors for CRKP infection or colonization. Results 222 patients were identified with K. pneumoniae clinical cultures during the study period; 99 (45%) were case patients and 123 (55%) were control patients. On multivariable analysis, factors associated with a significant risk for CRKP colonization or infection were solid organ or stem cell transplantation (OR, 5.05; 95% CI, 1.23 – 20.8, P=0.03), mechanical ventilation (OR, 2.56; 95% CI, 1.24 – 5.28, P=0.01), fecal incontinence (OR, 5.78; 95% CI, 1.52 – 22.0, P=0.01), and exposure in the prior 30 days to meropenem (OR, 3.55; 95% CI, 1.04 – 12.1, P=0.04), vancomycin (OR, 2.94; 95% CI, 1.18 – 7.32, P=0.02), and metronidazole (OR, 4.22; 95% CI, 1.28 – 14.0, P=0.02). Conclusions Rates 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.

<p>Risk Factors for Carbapenem-Resistant <em>Klebsiella pneumoniae</em> Bloodstream Infections and Outcomes</p>

“…The overuse of broad-spectrum antimicrobial agents and invasive procedures has led to an increase in the prevalence of drug-resistant K. pneumoniae and in the incidence of CRKP infection. 19,20 Our findings are consistent with those of other studies, which have reported a strong association between exposure to carbapenem agents and CRKP infection. 21,22 Carbapenem use may cause selective pressure on resistant microorganisms, thereby increasing the risk of infection.…”

Epidemiology and risk factors of rectal colonization of carbapenemase-producing Enterobacteriaceae among high-risk patients from ICU and HSCT wards in a university hospital

“…In order to prevent colonization, the investigation of the clinical predictors and risk factors for rectal CPE colonization brooks no delay. A recently published case-control study demonstrated solid organ and stem cell transplantation, mechanical ventilation, fecal incontinence, and exposure in the prior 30 days to carbapenems, vancomycin, and metronidazole as independent factors associated with CRE colonization [32]. In this prospective case-control study, operation of bronchoscopy, urinary system diseases, and combined use of antibiotics were demonstrated to be independent associated with rectal CPE colonization in high-risk patients from the ICU and HSCT wards.…”

Whole genome sequencing reveals high-resolution epidemiological links between clinical and environmental Klebsiella pneumoniae

“…This species is disseminated in healthcare settings via person-to-person contact, medical equipment, and contaminated environments [2, 3]. The emergence of multidrug-resistant K. pneumoniae is becoming an increasingly serious issue for clinical practice, largely related at the present time to isolates that express extended-spectrum β-lactamase (ESBL) enzymes that hydrolyze a broad spectrum of β-lactams [4, 5]. This is compounded by the emergence of K. pneumoniae that express carbapenemases such as KPC-type β-lactamase [5–7] and the recent detection of colistin-resistant K. pneumoniae due to the presence of the mcr-1 gene [8].…”

“…The emergence of multidrug-resistant K. pneumoniae is becoming an increasingly serious issue for clinical practice, largely related at the present time to isolates that express extended-spectrum β-lactamase (ESBL) enzymes that hydrolyze a broad spectrum of β-lactams [4, 5]. This is compounded by the emergence of K. pneumoniae that express carbapenemases such as KPC-type β-lactamase [5–7] and the recent detection of colistin-resistant K. pneumoniae due to the presence of the mcr-1 gene [8]. These resistance genes are carried on mobile genetic elements that facilitate their spread within and between bacterial species, a process that is likely to result in a rise in the number of K. pneumoniae infections that are very difficult to treat.…”