C2-3732. Emergence of blaKPC-Containing Klebsiella pneumoniae Isolates in a Long-Term Acute Care Facility (LTACF) in South Florida
Session: Slide Session: KPC β-Lactamase Continues to Go Global
Tuesday, October 28, 2008: 12:00 AM
Room: Independence A (Grand Hyatt)
Background:To date blaKPC-containing K. pneumoniae isolates (KPC-Kp) are responsible for hospital-acquired infections. KPC-Kp have not yet been detected in community and long-term care facility (LTCF) settings. Here, we report the recent identification of KPC-Kp in several patients from a LTACF located in South Florida. Methods: In a one month period (March 21st - April 18th, 2008), all K. pneumoniae isolates showing reduced susceptibility to carbapenems (MICs ≥ 4 mg/L) detected at Integrated Regional Laboratories (Ft. Lauderdale, FL) were studied. Phenotype screening for KPC production was performed with the modified Hodge test. PCR and sequence analysis for blaKPC, blaTEM, blaSHV, blaCTX-M was also performed. Clonal relatedness of isolates was investigated with the DiversiLab Microbial Typing System (Bacterial BarCode, bioMérieux). Results: We identified 10 non-duplicate K. pneumoniae isolates with reduced susceptibility to carbapenems. Seven isolates were collected from different patients recovered at the LTACF, whereas the remaining 3 isolates were from patients recovered at two hospitals in the same region. All isolates were positive by Hodge test for carbapenemases and PCR for blaKPC. The KPC-Kp from LTACF possessed blaKPC-3, blaTEM-1, and blaSHV-11. Of these, 5 isolates were included in a single genotype (>98% homology), whereas the remaining 2 shared a ≥ 93% homology with the first group. The 3 KPC-Kp detected in hospitalized patients were not related to the LTACF isolates. However, one of them was highly-related by typing to a KPC-Kp strain detected in Ohio. Conclusions: This report documents the dissemination of KPC-Kp strains outside the hospital environment. The spread of KPC-Kp in a LTACF (and nationally) represents a serious infection control and therapeutic challenge in a new clinical setting.
Aida Casiano-Colón, PhD, Rochester General Hospital, Rochester, NY, Andrea Hujer, MS, Louis Stokes Cleveland VAMC, Cleveland, OH, Andrea Endimiani, MD, VA Medical Center, Cleveland, OH, Federico Perez, MD, Fred Tenover, PhD, CDC, Atlanta, GA, R. Freedman, MD, AHMC, Robert Bonomo, MD, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH and  A. Endimiani, None.

Current Employment: Post-Doctoral Fellow
Division of Healthcare Outcomes Research
Department of Epidemiology and Preventive Medicine
University of Maryland, Baltimore
100 North Greene Street, Lower Level
Baltimore, MD 21201
Collegiate Institutions Attended:
Ph.D., Epidemiology
University of Maryland, Baltimore
Baltimore, MD
May 2005
Honors B.S., Microbiology & Honors B.A., International Studies
Oregon State University
Corvallis, OR
June 2001

John P. Quinn, MD is currently an attending physician in the Infectious Disease division at John Stroger Hospital of Cook County, Professor of Medicine at Rush University Medical Center and Scientific Director of a nonprofit research institute, the Chicago Infectious Disease Research Institute, all in Chicago, IL.
He is an AOA graduate of Rush Medical College and completed his Internal Residency at Loyola University in Maywood, IL, followed by an Infectious Disease fellowship at the University of Chicago.
His current research interests include molecular epidemiology, mechanisms of antimicrobial resistance in both gram-negative and gram-positive pathogenic bacteria and new drug development.

I am a clinical instructor specializing in transplant infectious diseases at the Mount Sinai School of Medicine in New York. I completed my medical school training at the Albert Einstein College of Medicine and completed both my residency and clinical ID fellowship training at the Mount Sinai School of Medicine.

I am an assistant professor specializing in antimicrobial resistance at the Case Western Reserve University School of Medicine in Cleveland.

Jeffrey Hageman is an epidemiologist in the Division of Healthcare Quality Promotion, National Center for Infectious Diseases, at the Centers for Disease Control and Prevention (CDC). Mr. Hageman completed his undergraduate degree in microbiology at Miami University and Master of Health Science in infectious disease epidemiology from Johns Hopkins School of Hygiene and Public Health. Mr. Hageman joined CDC in 1998 and has been with the Division of Healthcare Quality Promotion, formerly the Hospital Infections Program, since then. Mr. Hageman has published peer-reviewed articles on various infectious diseases topics and has conducted and assisted with outbreak investigations associated with emerging and antimicrobial-resistant pathogens. In his current position, he is responsible for coordinating and conducting activities related to antimicrobial-resistant Staphylococcus aureus. These activities include surveillance, field investigations, epidemiologic studies, laboratory testing, and public health management (e.g., outbreak response and control) of both vancomycin-resistant S. aureus and methicillin-resistant S. aureus (MRSA) in the community and healthcare settings. During the past few years he was also responsible for assisting with investigations of allograft-associated infections which have included transmission of Clostridium and Group A Streptococcus from cadaveric musculoskeletal tissues.

Director, VISN 10, Geriatrics, Research, Education, and Clinical Care Center, and Professor of Medicine, Pharmacology and Molecular Biology and Microbiology Case Western Reserve University School of Medicine.