Program Schedule

362
Modeling intrafacility spread of KPC-producing bacteria and impact of cohort strategies in long-term acute care hospitals in the Chicago region, USA

Session: Poster Abstract Session: Multidrug-resistant Organisms: Epidemiology and Prevention
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • Poster modeling intrafacility spread LTACHs Chicago landscape.pdf (373.2 kB)
  • Background: Nosocomial outbreaks of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) are being reported increasingly. The first recognition of KPC in metropolitan Chicago, Illinois, USA, was in 2007. Prevalence rose rapidly thereafter, especially in long-term acute care hospitals (LTACHs). Using mathematical models we studied the spread of KPCs in LTACHs, determined the transmission capacity of KPC, and investigated the effect of cohorting.

    Methods: Data on room occupancy, admission cultures, and every-other-week point prevalence cultures were available from four LTACHs in the Chicago region from June 2012 until June 2013. Three different cohort strategies were adopted at the LTACHs: a pure cohort (all KPC-positive patients on one floor), single rooms for KPC-positive patients, and a mixed cohort (all KPC-positive patients on one floor, supplemented with KPC-negative patients). A data-augmented Markov chain Monte Carlo method with Metropolis-Hastings algorithm was developed to model the transmission process in the LTACHs and to study the effect of different cohort strategies. The transmission process was described by the background transmission rate α (including transmissions independent of the colonization pressure, such as endogenous selection) and the patient-dependent transmission rate β (including transmissions dependent on the colonization pressure: β * ward prevalence). 

    Results: The average point prevalence of KPC among patients as calculated by the model was 35%. The overall estimates were 0.0022 for α and 0.011 for β. 18% of patients were colonized on admission to the LTACHs and sensitivity of the screening process to detect KPC was 81%. The number of acquisitions per 1000 patient days was lowest in the LTACHs with a pure cohort ward or private rooms for colonized patients compared to mixed cohort wards.

    Conclusion: The prevalence of KPC-producing bacteria in LTACHs is high, primarily due to a high admission prevalence and the resultant impact of high colonization pressure on risk of cross-transmission. Use of a pure cohort or single rooms for KPC-positive patients in LTACHs seemed to limit transmission compared to use of a mixed cohort.

    Manon Haverkate, MSc1,2, Martin Bootsma, PhD1,3, Michael Y. Lin, MD, MPH2, Shayna Weiner, MPH2, Donald Blom, RN, BA2, Karen Lolans, BS4, Nicholas Moore, MS4, Rosie D. Lyles, MD, MHA5, Robert a. Weinstein, MD, FIDSA2,5, Marc Bonten, MD PhD1,6 and Mary K. Hayden, MD, FSHEA, FIDSA2,4, (1)Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands, (2)Department of Internal Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, IL, (3)Department of Mathematics, Utrecht University, Utrecht, Netherlands, (4)Department of Pathology, Rush University Medical Center, Chicago, IL, (5)Department of Medicine, Cook County Health and Hospitals System, Chicago, IL, (6)Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands

    Disclosures:

    M. Haverkate, None

    M. Bootsma, None

    M. Y. Lin, None

    S. Weiner, None

    D. Blom, None

    K. Lolans, None

    N. Moore, None

    R. D. Lyles, None

    R. A. Weinstein, None

    M. Bonten, None

    M. K. Hayden, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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