1422. Screening for Colonization with Klebsiella pneumoniae Carbapenemase Producing Enterobacteriaceae in the Emergency Department Using a Prototype Multiplex PCR Assay
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Posters
  • Poster #1422.pdf (216.7 kB)
  • Background: KPC have become widely disseminated in NYC.  Prevalence is suspected to be high among both acute and long term care facilities.  The role of inter-institutional transfer of KPC colonized patients remains obscure.  Study objectives included investigation of the incidence of KPC colonization among ED patients at our institution, identifying risk factors for colonization and the exploration of potential strategies for KPC screening in the ED.

    Methods: Peri-rectal swabs were obtained from 206 adult ED patients admitted to our medical center prior to actual transfer to inpatient units during November 21 – December 29, 2011.  Samples were analyzed using a non-FDA approved prototype multiplex PCR assay capable of detecting all known variants of the KPC gene.  Data regarding demographic and clinical characteristics were collected and analyzed via univariate and multivariate methods to identify risk factors for patient colonization.

    Results: 4/206 pts (1.9%) were KPC positive.  Univariate analysis identified age >75 years (p=0.04), long term care residence (p=0.04), DNR status (p=0.01), antibiotic use in prior 3 months (p=0.03) and dementia (p<0.01) as risk factors.  Multivariate logistic regression identified recent hospitalization (acute care, rehab or long term care) [OR-7.3 (3.24-16.45)] and chronic respiratory disease [OR-3.07 (1.29-7.28)] as risk factors.  Additional selective sampling has now identified admission of KPC colonized patients from 11 different LTCFs and 3 different acute care hospitals.

    Conclusion:  

    1. KPC patient colonization is widespread among NYC hospitals and both acute care and LTCFs are reservoirs
    2. Inter-institutional transfer of colonized patients contributed significantly to MMC’s total inpatient KPC colonization prevalence (previously determined to be 4%)
    3. Screening of previously hospitalized patients in the ED would identify 50% of KPC+ patients and require PCR screening of 2060 patients on an annualized basis – further research is required to determine if this approach would be cost effective
    Noelle Burton, MD1, David Aguirre, BS2, Sharon Leung, MD3, Jacques Simkins, MD3 and Brian P. Currie, MD, MPH3, (1)Montefiore Medical Center, Bronx, NY, (2)Albert Einstein College of Medicine, Bronx, NY, (3)Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY

    Disclosures:

    N. Burton, None

    D. Aguirre, None

    S. Leung, None

    J. Simkins, None

    B. P. Currie, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 17th with the exception of research findings presented at the IDWeek press conferences.