1348. Transfer from a Long-Term Care Facility (LTCF) is a Major Risk Factor for Carriage of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae (KPC) among Hospitalized Patients
Session: Oral Abstract Session: The Menace of Klebsiella pneumoniae Carbapenemase (KPC)-Producing Organisms
Saturday, October 22, 2011: 2:30 PM
Room: 157ABC
Background: In Chicago, KPC was first recognized in December 2007 in a hospitalized patient transferred from a LTCF.  To inform KPC control measures, we evaluated whether transfer from a LTCF was a risk factor for KPC colonization at the time of acute care hospital admission.

Methods: We conducted a cross-sectional study of patients admitted to 4 Chicago area acute care hospitals from November 2010 to May 2011.  Hospitalized patients admitted from skilled nursing facilities without ventilator care (SNFs), skilled nursing facilities with ventilator care (VSNFs), and long-term acute care hospitals (LTACHs) were identified prospectively and matched 1:1 to community patients by age (±5 yrs), admitting clinical service, and date of admission (±2 weeks).  Rectal swab specimens were collected within 3 days of admission and cultured for KPC; blaKPC was confirmed by PCR. Patient characteristics were abstracted from medical records.  A nested case-control study was performed to identify other risk factors for KPC carriage among the cohort of LTCF patients.

Results: 174 patients transferred from LTCFs and 174 matched patients admitted from the community were studied.  KPC colonization was detected in 15 (8.6%) LTCF patients compared to 0 community patients (p<.0001).  LTCF subset prevalence was 2/133 (1.5%) in SNF patients, 9/30 (30%) in VSNF patients and 4/11 (36%) in LTACH patients.   In a multivariable logistic regression model of the 174 LTCF patient cohort, admission from a VSNF or LTACH (OR 12.5; 95% CI 2.5, 63.2) or having a G-tube (OR 14.8; 95% CI 1.7, 126) were independent risk factors for KPC-colonization.   Although KPC-carriage was previously unknown in 9/15 (60%) patients, 14/15 (93%) were in contact isolation for other reasons at the time of surveillance.  Patients with KPC were from 7/80 different LTCFs. All KPC were Klebsiella pneumoniae.

Conclusion: In Chicago, hospitalized patients transferred from LTCFs (especially VSNFs and LTACHs) are at increased risk of KPC colonization compared to patients admitted from the community.  Preemptive contact isolation and active surveillance of patients transferred from LTCFs to acute care hospitals may improve KPC control in regions where LTCFs are reservoirs of KPC.


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

Kavitha Prabaker, MD1,2, Michael Y. Lin, MD, MPH1, Margaret McNally, RN, BSN, PCCN 3, Sana Ahmed, MD4, Andrea Norris, DO4, Kartikeya Cherabuddi, MD5, Karen Lolans, BS1, Ruba Odeh, DO4, Vishnu Chundi, MD6, Robert Weinstein, MD, FIDSA7 and Mary Hayden, MD1, (1)Rush Univ. Med. Ctr., Chicago, IL, (2)Cook County Health and Hospitals System, Chicago, IL, (3)Our Lady of the Resurrection Med. Ctr., Chicago, IL, (4)Advocate Lutheran Gen. Hosp., Park Ridge, IL, (5)Westlake Hosp., Melrose Park, IL, (6)MIDC, Chicago, IL, (7)Cook County Health and Hosp. System, Chicago, IL

Disclosures:

K. Prabaker, None

M. Y. Lin, None

M. McNally, None

S. Ahmed, None

A. Norris, None

K. Cherabuddi, None

K. Lolans, None

R. Odeh, None

V. Chundi, 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.