507. Carbapenem-resistant Klebsiella pneumoniae in Emory University Affiliated Hospitals,
2006 - 2008
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Klebsiella pneumoniae harboring carbapenemase enzymes (KPC-KP) are emerging nosocomial pathogens. The first KPC-KP isolate at Emory University hospital was detected in September 2006, and in over two years its incidence has nearly doubled throughout the system
Methods: We conducted a retrospective case series study on all patients at 3 Emory University hospitals and a long -term acute care hospital (LTAC) located inside one of the hospitals, from whom KPC- KP were isolated during September 2006-December 2008. Demographics, inter-institutional transfer
of patients, source of clinical isolates, length of stay, outcomes were collected and incidence rate of infection/colonization per 10,000 patient-days was calculated.
Results: KPC-KP was recovered from 48 patients (median age 62 years, range 27-90 years). The incidence rate of infection/colonization increased from 0.35 per 10,000 patient-days in 2007 to 0.69 per 10,000 patient-days in 2008 (p =0.01). Urine was the most common site of isolation (50%), followed by lung (21%) and wound (17%). Fifteen (30%) patients died; 13 of the deceased had KPC-KP isolated from specimens other than urine or from multiple sites. 47 (97%) patients had either nosocomial or healthcare associated infections. 30 (62%) patients KPC- KP infection was classified as nosocomial since KPC was detected more than 48 hours after admission. 17 patients (35%) had healthcare associated acquisition of which 3 (19%) were from institutions outside the Emory hospitals. 19 patients were transferred among our facilities near the time or after KPC-KP isolation.
Conclusion: The incidence rate of KPC-KP infection/colonization was low, but results suggest a tendency toward an increased rate of acquisition over the study period; inter-institutional transfer may have facilitated the spread. Further studies, including molecular characterization of isolates and case-control study are under way to help determine KPC-KP transmission patterns in our facilities.
Eileen Burd, PhD, D(ABMM), William Flanders, MD, DSc2, Ketevan Kobaidze, MD, PhD3, David Kuhar, MD3, Kenneth Leeper, MD, FCCP3, Cindy McCloskey, MD3, Bruce Ribner, MD, MPH3, James Steinberg, MD and  K. Kobaidze, None..
J. P. Steinberg, None..
B. Ribner, None..
D. Kuhar, None..
K. V. Leeper, None..
C. McCloskey, None..
E. M. Burd, None..
W. D. Flanders, None., (1)Rollins School of Public Health, Atlanta, GA, (2)Emory University School of Medicine, Atlanta, GA