infection control & hospital epidemiology october 2015, vol. 36, no. 10 original article
Modeling Spread of KPC-Producing Bacteria in Long-Term Acute Care Hospitals in the Chicago Region, USA
Manon R. Haverkate, MSc;1,2 Martin C. J. Bootsma, PhD;1,3 Shayna Weiner, MPH;2 Donald Blom, RN;2
Michael Y. Lin, MD, MPH;2 Karen Lolans, BS;4 Nicholas M. Moore, MS;5 Rosie D. Lyles, MD;6 Robert A. Weinstein, MD;2,6 Marc J. M. Bonten, MD;1,7 Mary K. Hayden, MD;2,4 for the CDC Prevention Epicenter Program
objective. Prevalence of blaKPC-encoding Enterobacteriaceae (KPC) in Chicago long-term acute care hospitals (LTACHs) rose rapidly after the first recognition in 2007. We studied the epidemiology and transmission capacity of KPC in LTACHs and the effect of patient cohorting.
methods. Data were available from 4 Chicago LTACHs from June 2012 to June 2013 during a period of bundled interventions. These consisted of screening for KPC rectal carriage, daily chlorhexidine bathing, medical staff education, and 3 cohort strategies: a pure cohort (all KPC-positive patients on 1 floor), single rooms for KPC-positive patients, and a mixed cohort (all KPC-positive patients on 1 floor, supplemented with KPC-negative patients). A data-augmented Markov chain Monte Carlo (MCMC) method was used to model the transmission process.
results. Average prevalence of KPC colonization was 29.3%. On admission, 18% of patients were colonized; the sensitivity of the screening process was 81%. The per admission reproduction number was 0.40. The number of acquisitions per 1,000 patient days was lowest in LTACHs with a pure cohort ward or single rooms for colonized patients compared with mixed-cohort wards, but 95% credible intervals overlapped.
conclusions. Prevalence of KPC in LTACHs is high, primarily due to high admission prevalence and the resultant impact of high colonization pressure on cross transmission. In this setting, with an intervention in place, patient-to-patient transmission is insufficient to maintain endemicity. Inclusion of a pure cohort or single rooms for KPC-positive patients in an intervention bundle seemed to limit transmission compared to use of a mixed cohort.
Infect. Control Hosp. Epidemiol. 2015;36(10):1148–1154
introduction
United States, in 1996.4 The first recognition of KPC in the Chicago region (Illinois, USA) occurred in 2007 and since then, numbers have been rising. A point-prevalence survey in
One of the most threatening recent developments to face hospitals is the emergence of carbapenemase-producing Enterobacteriaceae (CPE).1 Nosocomial outbreaks of CPE are being reported with increasing frequency.2,3 Different types of CPE exist, including Enterobacteriaceae that produce Klebsiella pneumoniae carbape- nemases (KPC),4 which represent a major problem in short-stay hospitals and especially in long-term acute care hospitals (LTACHs).5–8 There, vulnerable patients are in close proximity to each other and multidrug-resistant organisms can spread easily.9 KPC was first identified in an isolate from North Carolina,
24 acute-care hospitals and 7 LTACHs in 2011 showed that 3.3% of adult patients in short-stay hospital intensive care units (ICUs) and 30.4% of LTACH residents were colonized with KPC.10
LTACHs are assumed to be a driving force behind the KPC epidemic due to high prevalence, high transmission rates, and patient movement between facilities.7,11–13 The potential for the regional spread of antibiotic resistance has been demonstrated extensively.14–17 Several studies have incorporated patient move- ment inmodels of infectious disease spread, ie, for pathogens such asClostridiumdifficile,18 methicillin-resistant Staphylococcus aureus (MRSA),16,19–21 and vancomycin-resistant enterococci.22 No model is available for the spread of KPCs in LTACHs. Further- more, the optimal strategy to contain the spread ofGram-negative bacteria, including KPCs, in LTACHs is unknown.12,23
Affiliations: 1. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; 2. Department of
Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States; 3. Department of Mathematics, Utrecht University, Utrecht, The Netherlands; 4. Department of Pathology, Rush University Medical Center, Chicago, Illinois, United States; 5. Department of Medical Laboratory Science, Rush University Medical Center, Chicago, Illinois, United States; 6. Department of Medicine, Division of Infectious Diseases, Cook County Health and Hospital System, Chicago, Illinois, United States; 7. Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Preliminary results from this study were presented at IDWeek 2014; October 8–12, 2014, Philadelphia, Pennsylvania, USA.
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2015/3610-0004. DOI: 10.1017/ice.2015.163 Received March 18, 2015; accepted June 20, 2015; electronically published July 24, 2015
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140