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Clin Infect Dis. 2015 Apr 15;60(8):1153-61. doi: 10.1093/cid/ciu1173. Epub 2014 Dec 23.

Prevention of colonization and infection by Klebsiella pneumoniae carbapenemase-producing enterobacteriaceae in long-term acute-care hospitals.

Author information

1
Departments of Medicine, Division of Infectious Diseases Pathology.
2
Departments of Medicine, Division of Infectious Diseases.
3
Pathology.
4
Medical Laboratory Science.
5
Nursing, Rush University Medical Center.
6
Department of Biostatistics, University of Illinois School of Public Health.
7
Department of Medicine, Division of Infectious Diseases, Cook County Health and Hospital System.
8
Metro Infectious Disease Consultants LLC, Chicago, Illinois.
9
Departments of Medicine, Division of Infectious Diseases Department of Medicine, Division of Infectious Diseases, Cook County Health and Hospital System.

Abstract

BACKGROUND:

Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (hereafter "KPC") are an increasing threat to healthcare institutions. Long-term acute-care hospitals (LTACHs) have especially high prevalence of KPC.

METHODS:

Using a stepped-wedge design, we tested whether a bundled intervention (screening patients for KPC rectal colonization upon admission and every other week; contact isolation and geographic separation of KPC-positive patients in ward cohorts or single rooms; bathing all patients daily with chlorhexidine gluconate; and healthcare-worker education and adherence monitoring) would reduce colonization and infection due to KPC in 4 LTACHs with high endemic KPC prevalence. The study was conducted between 1 February 2010 and 30 June 2013; 3894 patients were enrolled during the preintervention period (lasting from 16 to 29 months), and 2951 patients were enrolled during the intervention period (lasting from 12 to 19 months).

RESULTS:

KPC colonization prevalence was stable during preintervention (average, 45.8%; 95% confidence interval [CI], 42.1%-49.5%), declined early during intervention, then reached a plateau (34.3%; 95% CI, 32.4%-36.2%; P<.001 for exponential decline). During intervention, KPC admission prevalence remained high (average, 20.6%, 95% CI, 19.1%-22.3%). The incidence rate of KPC colonization fell during intervention, from 4 to 2 acquisitions per 100 patient-weeks (P=.004 for linear decline). Compared to preintervention, average rates of clinical outcomes declined during intervention: KPC in any clinical culture (3.7 to 2.5/1000 patient-days; P=.001), KPC bacteremia (0.9 to 0.4/1000 patient-days; P=.008), all-cause bacteremia (11.2 to 7.6/1000 patient-days; P=.006) and blood culture contamination (4.9 to 2.3/1000 patient-days; P=.03).

CONCLUSIONS:

A bundled intervention was associated with clinically important and statistically significant reductions in KPC colonization, KPC infection, all-cause bacteremia, and blood culture contamination in a high-risk LTACH population.

KEYWORDS:

Klebsiella pneumoniae carbapenemase; carbapenem-resistant Enterobacteriaceae; healthcare-associated infection; infection prevention; long-term acute-care hospital

PMID:
25537877
DOI:
10.1093/cid/ciu1173
[Indexed for MEDLINE]

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