Background: LTACHs have high prevalence of KPC, but few studies have investigated the risk factors.
Methods: We conducted a case-control study to determine risk factors for acquisition of KPC rectal colonization in patients at 4 LTACHs from 6/2012 - 6/2013 during a bundled KPC control intervention (KPC admission and biweekly screening; contact isolation and geographic separation of KPC-positive patients; daily chlorhexidine bathing; worker education and adherence monitoring). Cases were patients with a negative admission screening culture and a positive screening culture later during the LTACH stay. Controls were patients with a negative screening culture at admission who remained KPC negative during the LTACH stay. Cases and controls were matched 1:1 by admission date, LTACH, and exposure time (time from admission to KPC acquisition for case, and same length of time for control). Date of KPC acquisition was defined as the midpoint between the last negative and the first positive screening cultures. Medical records were reviewed for patient characteristics and all medical device use; medication exposures between date of last negative screening culture and KPC acquisition were tallied. Ward-level colonization pressure was calculated at date of last negative screening culture (number of KPC-positive patients on ward ÷ total number of patients on ward).
Results: 100 control and 100 case patients were studied. Patient demographics and exposure time were similar in both groups (Table). In univariate analysis, case patients were more likely to be confused, bed bound, and incontinent; to have a gastric tube; to have received beta lactam, carbapenem, or antianaerobic antibiotics; and to be exposed to higher colonization pressure (Table). In a multivariable logistic regression model, higher colonization pressure, higher Charlson's comorbidity index, and carbapenem exposure were independently associated with KPC acquisition (Table, Figure). For each 10% increase in colonization pressure, odds of KPC acquisition increased by 25%.
Conclusion: LTACH patients who were surrounded by more KPC-positive patients, who had more comorbidities, and who received carbapenems were at increased risk of acquiring KPC colonization.
M. Haverkate, None
K. Lolans, None
N. M. Moore, None
S. Weiner, None
R. D. Lyles, Clorox: Employee , Salary
D. Blom, None
Y. Rhee, None
S. Kemble, None
L. Fogg, None
D. W. Hines, None
R. A. Weinstein, None
M. K. Hayden, Sage Products, Inc.: Sage provided CHG product at no cost to facilities involved in this study. , Sage provided CHG product at no cost to facilities involved in this study.
F. T. CDC Prevention Epicenters Program, None