1614. How fast do patients acquire Klebsiella pneumoniae (Kp) containing blaKPC (Kp KPC)? An Analysis of Epidemiology of Kp KPC at a Long-Term Acute Care Facility
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA_KPC_Awali.pdf (610.1 kB)
  • Background: Infections due to Kp KPC are an emerging threat to long-term acute care hospitals (LTACs), which typically admit chronically and critically ill patients. Data regarding the rapidity of acquisition of Kp KPC are not yet available. This knowledge has implications for the development of containment and screening strategies in LTACs.   Methods: A retrospective chart review of 30 patients with Kp KPC isolates obtained from Dec. 2010 through Aug. 2012 was conducted in a 77-bed LTAC in Detroit, MI, to analyze the timing of acquisition, incidence pattern, possible modes of transmission, and 30-day and 1-year overall mortality rates among patients. PCR gene amplification, repetitive-sequence-based PCR (rep-PCR) and multilocus sequence typing (MLST) was performed to determine the clonal relationships between eight of the CRE isolates.   Results: Of the 30 patients identified, 24 (80%) were infected and 6 (20%) were colonized with Kp KPC. The mean age of patients was 70 11.5 years, 19 (63%) were females, and 25 (83%) were African-Americans. 24 (80%) patients acquired Kp KPC more than 48 hours after admission.   Among those infected, 20 (83%) had bloodstream infections and 4 (17%) had urinary tract infections. Among the 6 colonized patients, sites included urine 3 (50%), sputum 2 (33%) and genital discharge 1 (17%). The 30-day all-cause mortality rate was 17% (n=5), and the 1-year all-cause mortality rate was 30% (n=9). Eight representative strains were further studied. Molecular genotyping using rep-PCR demonstrated a similarity index of > 95% between the eight strains of Kp KPC, indicating they were clonally related (Fig 1). Furthermore, comparison to the reference strain 300/1240 suggested that all eight isolates belonged to the MLST sequence ST258 and contained the blaKPC-3 sequence.   Conclusion: As 80% of residents acquired Kp KPC after 48 h of admission to an LTAC, isolation and containment strategies using conventional microbiological methods may be adequate to prevent new acquisition of Kp KPC in LTACs. This time to acquisition is consistent with either environmental or person to person spread.

    Figure 1. Dendrogram and similarity matrix for K. pneumonia for eight isolates.

    Reda Awali, MD, MPH1, Caitlin Biedron, M.S.2, Uzma Imran, MD1, Olufemi Jegede, MPH1, Harleen Kaur, MD1, Brindha Gopala Krishnan, MD1, Satya Datla, MBBS1, Dina Boikov, MD3, William Lebar, MS4, Robert A. Bonomo, MD5, Federico Perez, MD6, Keith Kaye, MD, MPH, FIDSA, FSHEA1 and Teena Chopra, MD, MPH1, (1)Infectious Diseases, Detroit Medical Center/ Wayne State University, Detroit, MI, (2)Wayne State University, Detroit, MI, (3)Detroit Medical Center/ Wayne State University, Detroit, MI, (4)Univeristy of Michigan, Ann Arbor, MI, (5)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (6)University Hospitals Case Medical Center, Cleveland Heights, OH

    Disclosures:

    R. Awali, None

    C. Biedron, None

    U. Imran, None

    O. Jegede, None

    H. Kaur, None

    B. Gopala Krishnan, None

    S. Datla, None

    D. Boikov, None

    W. Lebar, None

    R. A. Bonomo, None

    F. Perez, None

    K. Kaye, None

    T. Chopra, None

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