1347. Skin colonization with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) among long-term acute care hospital (LTACH) patients
Session: Oral Abstract Session: The Menace of Klebsiella pneumoniae Carbapenemase (KPC)-Producing Organisms
Saturday, October 22, 2011: 2:15 PM
Room: 157ABC

Background: Unrecognized patient colonization and environmental contamination may facilitate cross-transmission of KPC at LTACHs. We assessed sites of KPC colonization on bodies and in environments of LTACH patients.

Methods: We evaluated 17 patients detected during a wider KPC screening project at 4 LTACHs. Swab specimens from each of 7 anatomic sites (rectal, inguinal, axillary, antecubital, low back, urine, oropharyngeal/tracheal secretions) and up to 20 environmental sites (e.g., bed rails, overbed table, ventilator) were collected. Swabs were inoculated into tryptic soy broth + 1 g/ml meropenem or plated directly to MacConkey agar + 2 ertapenem disks. blaKPC was confirmed by PCR. Isolates were identified to species (MicroScan).

Results: Mean age was 65 years; 16 (94%) were mechanically ventilated, 14 (82%) had fecal incontinence and all were bedfast. On day of surveillance, 14 (82%) patients were receiving > 1 antibiotic and median length of LTACH stay was 55 days.

Extra-rectal colonization with KPC was found in all patients. 16/17 (94%) patients had at least 1 skin site positive for KPC. 11/17 (65%) patients had 3 or more anatomic sites positive for KPC. Six (35%) patients had KPC identified in a clinical culture in the prior 2-7 weeks; these patients had more body sites positive by surveillance than did patients without a positive clinical culture (median 4.5 vs 3.0 sites, respectively, P= 0.04). Patients were colonized with the following KPC: 14 K. pneumoniae, 1 Enterobacter aerogenes, 1 E. aerogenes + K. pneumoniae, 1 K. pneumoniae + Escherichia coli.

None of 151 patient room sites or 71 common area sites cultured grew KPC, although 41/222 (18%) environmental sites grew other carbapenem-resistant gram-negative pathogens.

Broth enrichment detected KPC in only 1 additional body site that was negative by direct plating.

Conclusion: In a sample of LTACH patients, KPC colonization at multiple body sites was common. We detected no KPC environmental contamination in rooms of KPC-colonized patients. Frequent colonization of multiple skin sites by KPC suggests that antiseptic skin cleansing may be a useful strategy to decrease cross-transmission of KPC in LTACHs.

 


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Caroline J. Thurlow, MD1,2, Kavitha Prabaker, MD1,3, Michael Y. Lin, MD, MPH1, Karen Lolans, BS1, Margaret Feller, RN4, Sheila Collins-Johnson, RN5, Ninfa Acuna, RN6, JoAnne Marie Gasienica, RN7, Julie Rodriguez, PA-C4, Sharon Norris, RN8, David W. Hines, MD4, Joel B. Spear, MD9, Robert Weinstein, MD, FIDSA1,2 and Mary Hayden, MD1, (1)Rush Univ. Med. Ctr., Chicago, IL, (2)Cook County Health and Hosp. System, Chicago, IL, (3)Cook County Health and Hospitals System, Chicago, IL, (4)Metro Infectious Disease Consultants, LLC, Hinsdale, IL, (5)Kindred Hosp. of Chicago Northlake, Northlake, IL, (6)Kindred Chicago Lakeshore Hosp., Chicago, IL, (7)Kindred Hosp. Chicago North, Chicago, IL, (8)Kindred Chicago Central Hosp., Chicago, IL, (9)Saint Joseph Hosp., Chicago, IL

Disclosures:

C. J. Thurlow, None

K. Prabaker, None

M. Y. Lin, None

K. Lolans, None

M. Feller, None

S. Collins-Johnson, None

N. Acuna, None

J. M. Gasienica, None

J. Rodriguez, None

S. Norris, None

D. W. Hines, None

J. B. Spear, None

R. Weinstein, None

M. Hayden, Sage: Grant Investigator, Grant recipient
3M: Grant Investigator, Grant recipient
Cardinal Health: Consultant, Speaker honorarium

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.