Screening of nursing home residents for colonization with carbapenem-resistant Enterobacteriaceae admitted to acute care hospitals: Incidence and risk factors

• Published in: American journal of infection control 2016-02, Vol.44 (2), p.126-130
• Main Authors: Cunha, Cheston B., MD, Kassakian, Steven Z., MD, Chan, Ryan, MPH, Tenover, Fred C., PhD, Ziakas, Panos, MD, Chapin, Kimberle C., MD, Mermel, Leonard A., DO, ScM
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Bacterial Proteins - genetics; beta-Lactam Resistance; beta-Lactamases - genetics; Carbapenem resistance; Carbapenem-resistant Enterobacteriaceae; Carbapenemase-producing Enterobacteriaceae; Carbapenems - pharmacology; Case-Control Studies; CRE bacteria; Cross Infection - epidemiology; Cross Infection - microbiology; Disease control; Enterobacteriaceae - drug effects; Enterobacteriaceae - enzymology; Enterobacteriaceae - genetics; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; Feces - microbiology; Female; Gram-negative bacteria; Hospitalization; Hospitals; Humans; Incidence; Infection Control; Infectious Disease; Klebsiella Infections - epidemiology; Klebsiella Infections - microbiology; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - enzymology; Klebsiella pneumoniae - genetics; Male; Medical screening; Middle Aged; Multidrug resistant organisms; Nursing Homes; Rhode Island - epidemiology; Risk Factors; Young Adult
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2015.09.019

Background There are increasing reports of multidrug-resistant gram-negative bacilli in nursing homes and acute care hospitals. Methods We performed a point prevalence survey to detect fecal carriage of gram-negative bacteria carrying carbapenem resistance genes or which were otherwise resistant to carbapenem antibiotics among 500 consecutive admissions from local nursing homes to 2 hospitals in Providence, Rhode Island. We performed a case-control study to identify risk factors associated with carriage of carbapenem-resistant Enterobacteriaceae (CRE). Results There were 404 patients with 500 hospital admissions during which they had rectal swab samples cultured. Fecal carriage of any carbapenem-resistant or carbapenemase- producing gram-negative bacteria was found in 23 (4.6%) of the 500 hospital admissions, including 7 CRE (1.4%), 2 (0.4%) of which were Klebsiella pneumoniae carbapenemase (ie, blaKPC ) producing (CPE) Citrobacter freundii , 1 of which was carbapenem susceptible by standard testing methods. Use of a gastrostomy tube was associated with CRE carriage ( P  = .04). We demonstrated fecal carriage of carbapenem-resistant or carbapenemase-producing gram-negative bacteria in 4.6% of nursing home patients admitted to 2 acute care hospitals, but only 0.4% of such admissions were patients with fecal carriage of CPE. Use of gastrostomy tubes was associated with fecal carriage of gram-negative bacteria with detectable carbapenem resistance. Conclusion CRE fecal carriage is uncommon in our hospital admissions from nursing homes.