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361
Duration of colonization with KPC-producing bacteria at long-term acute care hospitals in Chicago, 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 colonization duration KPC landscape.pdf (364.5 kB)
  • Background: Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) are endemic in the USA and prevalence is especially high in long-term acute care hospitals (LTACHs). There, vulnerable patients are in close proximity to each other, allowing infections to spread easily. Another important aspect of LTACHs is the high readmission rate which can create a feedback loop, in which readmitted patients re-introduce the pathogen into the facility. Knowledge about the duration of colonization with KPC is essential to identify patients at risk of KPC carriage and to control the spread of KPC in LTACHs.

    Methods: Data were collected from November 2011 until June 2013 in four LTACHs in the Chicago region, Illinois, USA. All LTACH patients were screened on admission for KPC and every-other-week point prevalence cultures were taken. All patients with at least one episode of KPC colonization were included in the analyses. The duration of colonization was assessed using a maximum likelihood analysis, which can take into account (false) negative cultures in between positive cultures and can simultaneously assess the sensitivity of the screening test for KPC. Furthermore, we looked at the time between discharge and readmission of patients and assessed the clearance rate in this period, taking interval-censoring into account.

    Results: Using data from 625 patients (1065 cultures), the median duration of colonization with KPC was estimated to be 16 months when assuming that negative cultures in between positive cultures were false negative. The corresponding sensitivity was 82%. 242 (re-) admissions were available of 166 patients to assess the duration of colonization after discharge from the LTACH, assuming that patients are ‘at risk’ of clearance of KPC in this period. In that analysis, the median duration of colonization was 11 months.

    Conclusion: About half of the LTACH patients colonized with KPC are still carriers after a year. Colonized patients seem to require isolation or other infection control precautions for a prolonged time.

    Manon Haverkate, MSc1,2, Shayna Weiner, MPH1, Michael Y. Lin, MD, MPH1, Donald Blom, RN, BA1, Karen Lolans, BS3, Nicholas Moore, MS3, Rosie D. Lyles, MD, MHA4, Kavya Poluru3, Llu´sa Guillem3, Robert a. Weinstein, MD, FIDSA1,4, Marc Bonten, MD PhD2,5, Mary K. Hayden, MD, FSHEA, FIDSA1,3 and Martin Bootsma, PhD2,6, (1)Department of Internal Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, IL, (2)Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands, (3)Department of Pathology, Rush University Medical Center, Chicago, IL, (4)Department of Medicine, Cook County Health and Hospitals System, Chicago, IL, (5)Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands, (6)Department of Mathematics, Utrecht University, Utrecht, Netherlands

    Disclosures:

    M. Haverkate, None

    S. Weiner, None

    M. Y. Lin, None

    D. Blom, None

    K. Lolans, None

    N. Moore, None

    R. D. Lyles, None

    K. Poluru, None

    L. Guillem, None

    R. A. Weinstein, None

    M. Bonten, None

    M. K. Hayden, None

    M. Bootsma, 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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