Emergence and rapid regional spread of klebsiella pneumoniae carbapenemase-producing enterobacteriaceae

Sarah Y. Won, Luisa Munoz-Price, Karen Lolans, Bala Hota, Robert A. Weinstein, Mary K. Hayden

Research output: Contribution to journalArticle

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Abstract

Summary. Exposure network analysis and molecular epidemiologic methods were used to analyze the emergence and regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae over a 1-year period. Although 40 patients and 26 health care facilities were affected, 1 long-term acute care hospital played a critical role in the convergence of patients at high risk, amplification by cross-infection, and dissemination of these multidrug-resistant bacteria.Background.Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae are an emerging antibiotic resistance threat with demonstrated epidemic potential.Methods.We conducted an outbreak investigation of KPC-producing Enterobacteriaceae among patients of acute and long-term acute care hospitals (LTACHs) in 4 adjacent counties in Indiana and Illinois from 1 January 2008 through 31 December 2008 (cases). The study used traditional and molecular epidemiologic methods and an adaptation of social network analysis ("exposure network analysis").Results.Clinical records for 40 (95%) of 42 patients were available. Patients were mostly older with multiple comorbid conditions. Eleven patients (27.5%) died during the index hospitalization or were discharged to hospice; 23 (57.5%) were discharged to a nursing home, and 4 (10.0%) were discharged to home. One LTACH (LTACH-A) was central to the regional outbreak: 24 (60%) of 40 cases were linked to LTACH-A, and at least 10 patients (25%) acquired KPC there. Of 16 cases not linked to LTACH-A, 12 (75%) were linked to 3 nursing homes. Only 4 patients (10%) definitely acquired KPC during an acute care hospital stay. Molecular typing revealed the 31 available KPC-positive K. pneumoniae isolates to be similar and to cluster with epidemic multilocus sequence type 258; 2 KPC-positive Escherichia coli isolates were unique.Conclusions.We observed extensive transfer of KPC-positive patients throughout the exposure network of 14 acute care hospitals, 2 LTACHs, and 10 nursing homes. Although few cases were identified at most institutions, many facilities were affected. Successful control of KPC-producing Enterobacteriaceae will require a coordinated, regional effort among acute and long-term health care facilities and public health departments.

Original languageEnglish
Pages (from-to)532-540
Number of pages9
JournalClinical Infectious Diseases
Volume53
Issue number6
DOIs
StatePublished - Sep 15 2011

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Klebsiella pneumoniae
Enterobacteriaceae
Long-Term Care
Nursing Homes
Epidemiologic Methods
Health Facilities
Disease Outbreaks
Delivery of Health Care
carbapenemase
Molecular Typing
Hospices
Microbial Drug Resistance
Cross Infection
Social Support
Length of Stay
Hospitalization
Public Health
Escherichia coli
Bacteria

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Won, S. Y., Munoz-Price, L., Lolans, K., Hota, B., Weinstein, R. A., & Hayden, M. K. (2011). Emergence and rapid regional spread of klebsiella pneumoniae carbapenemase-producing enterobacteriaceae. Clinical Infectious Diseases, 53(6), 532-540. https://doi.org/10.1093/cid/cir482

Emergence and rapid regional spread of klebsiella pneumoniae carbapenemase-producing enterobacteriaceae. / Won, Sarah Y.; Munoz-Price, Luisa; Lolans, Karen; Hota, Bala; Weinstein, Robert A.; Hayden, Mary K.

In: Clinical Infectious Diseases, Vol. 53, No. 6, 15.09.2011, p. 532-540.

Research output: Contribution to journalArticle

Won, SY, Munoz-Price, L, Lolans, K, Hota, B, Weinstein, RA & Hayden, MK 2011, 'Emergence and rapid regional spread of klebsiella pneumoniae carbapenemase-producing enterobacteriaceae', Clinical Infectious Diseases, vol. 53, no. 6, pp. 532-540. https://doi.org/10.1093/cid/cir482
Won, Sarah Y. ; Munoz-Price, Luisa ; Lolans, Karen ; Hota, Bala ; Weinstein, Robert A. ; Hayden, Mary K. / Emergence and rapid regional spread of klebsiella pneumoniae carbapenemase-producing enterobacteriaceae. In: Clinical Infectious Diseases. 2011 ; Vol. 53, No. 6. pp. 532-540.
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AU - Weinstein, Robert A.

AU - Hayden, Mary K.

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