Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) is highly antibiotic-resistant and poses a serious threat to patients (pts) and to healthcare systems. Since our first KPC-KP was identified in early 2009, we noted that a significant number of patients with brain and spinal cord injuries (BSCIs) were present in our KPC-KP population. We studied the prevalence of BSCI pts among our KPC-KPs, investigated clinical characteristics, and analyzed the strains recovered from these patients.
A retrospective cohort study was performed at Northwestern Memorial Hospital (NMH) to identify all KPC-KP cases from February 2009 to December 2014. Electronic medical records were reviewed to determine the clinical characteristics including demographics, underlying conditions, time from admission to KPC-KP isolate, number of prior admissions, culture site, and duration of colonization. KPCs was confirmed by KPC-specific polymerase chain reaction (PCR). Patients with multiple KPC-KPs were defined as those with KPC-KP isolates detected in different calendar months. Two archived KPC-KP isolates recovered from separate cultures of the same patient were compared with pulsed field gel electrophoresis (PFGE) and used to calculate the duration of colonization.
Of 218 pts with KPC-KP, 86 (39%) were BSCI pts. Of these 27 (31%) had multiple KPC-KPs, and 20 (74%) pt’s isolates were available for analysis. Of these 20, average age was 45 yrs, 15 (75%) were male, 15 (75%) were African American, and average Charlson score was 3.5 (range 2-13). The majority (n=17; 85%) of pts had SCI. The average time from admission to KPC-KP detection was 1.5 d (range 0-11 days), and the average number of prior admissions to NMH was15 (range 0-82). KPC-KP isolates were from urine in 17 (85%), blood 1 (5%), surveillance culture 1 (5%) and blood and surveillance culture 1 (5%). Thirteen (65%) patients were infected or colonized with the same strain type over time, and the strain persisted on average 372 days.
BSCI patients comprise a significant percentage of our KPC-KP population. Due to repeated hospitalizations and prolonged colonization, they represent a substantial reservoir for these multidrug-resistant pathogens.
M. Malczynski, None
C. Qi, None
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