1349. Prevalence of Carbapenemase producing Klebsiella pneumoniae Colonization at an Academic Medical Center in New York City
Session: Oral Abstract Session: The Menace of Klebsiella pneumoniae Carbapenemase (KPC)-Producing Organisms
Saturday, October 22, 2011: 2:45 PM
Room: 157ABC
Background: Carbapenemase producing Klebsiella pneumoniae (KPC) are endemic in NYC. We performed a comparison between culture and a prototype PCR assay to assess the prevalence of KPC colonization at Montefiore Medical Center. We also assessed anatomical sites for sampling strategies and risk factors for KPC colonization.

Methods: We sampled every ICU patient, every third inpatient and 97 Emergency Room (ER) patients scheduled to be admitted during a 4 wk period. Perianal swabs were obtained from all patients, and wound and urine specimens from those with chronic wounds and with Foley catheters or history of recurrent urinary tract infections. Specimens were first cultured, and then PCR tested. Culture utilized meropenem supplemented MacConkey agar plates followed by Vitek 2. PCR used primers designed to qualitatively identify the KPC gene. Enriched broth culture and gene sequencing were used to evaluate discordant cases.

Results: 316 patients (53% from non-ICU units, 17% from ICUs and 31% from ER) were screened, and 418 specimens (76% perianal, 18% urine and 6% wound) were collected. Hospital prevalence of KPC colonization was 14/316 (4%). It was higher in non-ICU units than in ICUs, (7% vs. 2%) and among medicine compared to surgical patients, (9% vs.3%), but rates were not significantly different. 14 patients and 20 specimens were PCR+ for KPC. Of those, 10 patients and 14 specimens were also culture + for KPC. 4/6 PCR+/culture- discordant specimens were + for KPC by enriched broth. There were 2 specimens that were PCR-/culture+ that are awaiting gene sequencing. Of the 14 patients with +PCR for KPC, perianal sampling detected all cases. KPC colonized patients were more likely to be DNR (29% vs. 7%), admitted from nursing homes (NH) (50% vs. 13%), to have received antibiotics within prior 3 months (86% vs. 56%), to have prior + culture for KPC (57% vs. 1%), and to be admitted for > 2 wks prior sampling (43% vs. 15%). All were significant at P ≤ 0.03.

Conclusion: KPC colonization prevalence was highest among non-ICU inpatients, particularly among medicine patients. PCR detected more KPC cases than culture testing did. The perianal site appears sufficient for sampling. KPC colonization was more frequent in patients admitted from NH and with recent exposure to antibiotics.


Subject Category: D. Diagnostic microbiology

Jacques Simkins, MD1, Reha Pokharel, MD2, Samriti Dogra, MD3, Phillip Gialanella, MS4, Sanjita Ravishankar, MD4, Michael Levi, ScD4 and Brian P Currie, MD, MPH1, (1)Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, (2)Research, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, (3)Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, (4)Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY

Disclosures:

J. Simkins, None

R. Pokharel, None

S. Dogra, None

P. Gialanella, None

S. Ravishankar, None

M. Levi, None

B. P. Currie, Becton, Dickinson and Co: Investigator, Research support

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.