1604. Carbapenem Resistant Klebsiella pneumoniae: Epidemiology of the Regional Spread in Southern Indiana and Barriers for Prevention
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • 41241 IDSA.pdf (187.4 kB)
  • Background: The emergence of carbapenem resistance among Enterobacteriaceae (CRE) represent a serious threat to public health. The most common type of carbapenemase in the United States is the Klebsiella pneumoniae carbapenemase (KPC).

    Methods: We conducted a retrospective study of cases of KPC identified in Evansville, Indiana, between September 2009, and March 2013. We identified all the KPC isolated at the two acute care hospitals microbiology laboratories, and reviewed the clinical data. Patients were admitted in two acute care hospitals (ACH), one long-term acute care hospital (LTAC), and one rehabilitation hospital (RH).

    Results: Sixteen patients were identified with KPC in the studied period. Thirteen KPC patients were identified at the LTAC, one from each ACH, and one at a nursing home. Four patients had KPC isolated after their transfer from the LTAC, either to ACH or to the RH. There was a significant rate of transfer of patients among the facilities and half of the cases were admitted to the LTAC from ACH’s other than the two local ACH. Eleven cases were identified during a 10 month interval while the other 5 cases were spread over 33 months of study.

    Patients were older with multiple comorbid conditions. More than one third were on dialysis, and one third on ventilator. The KPC isolates were obtained from urine (6), respiratory secretions (6), blood (4), and wound (1). Many patients also had infections with other multidrug resistant organisms. Five patients (30%) died within 30 days of the KPC isolation and 60% within one year.

    Several barriers for prevention of KPC spread were identified during the investigation. Every hospital in the region and every ID physician is independent. Infection Control supervision was done by a different ID physician at each of the four hospitals in the area. At the LTAC, which was central to the regional outbreak, the ID physicians work on a monthly rotation and that made identification of trends more difficult.

    Conclusion: Although most of the cases were identified at the LTAC, all hospitals in the region were affected. Successful control of CRE will require a coordinated, regional effort among acute and long-term health care facilities. Laboratories will need to identify the multiple mechanisms by which organisms develop carbapenem resistance.

    Emilian Armeanu, MD1,2, Jose Salgado, MD, MPH3, Marcia Morgan, MS3, Mubashir Zahid, MD2 and Gayle Stubbs, PhD2, (1)Select Specialty Hospital, Evansville, IN, (2)Deaconess Hospital, Evansville, IN, (3)St. Mary Medical Center, Evansville, IN


    E. Armeanu, None

    J. Salgado, None

    M. Morgan, None

    M. Zahid, None

    G. Stubbs, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.