Cohorting KPC+ Klebsiella pneumoniae (KPC-Kp)-positive patients: A genomic exposé of cross-colonization hazards in a long-term acute-care hospital (LTACH)

Cohorting patients who are colonized or infected with multidrug-resistant organisms (MDROs) protects uncolonized patients from acquiring MDROs in healthcare settings. The potential for cross transmission within the cohort and the possibility of colonized patients acquiring secondary isolates with ad...

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Bibliographic Details
Published in:Infection control and hospital epidemiology 2020-10, Vol.41 (10), p.1162-1168
Main Authors: Hawken, Shawn E, Hayden, Mary K, Lolans, Karen, Yelin, Rachel D, Weinstein, Robert A, Lin, Michael Y, Snitkin, Evan S
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Antibiotic resistance
Antibiotics
Bacterial Proteins - genetics
beta-Lactamases - genetics
Colonization
Drug resistance
Genes
Genomes
Genomics
Health care
Hospitals
Humans
Infections
Intervention
Klebsiella Infections - drug therapy
Klebsiella Infections - epidemiology
Klebsiella pneumoniae - genetics
Pathogens
Patients
Software
Surveillance
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Summary:Cohorting patients who are colonized or infected with multidrug-resistant organisms (MDROs) protects uncolonized patients from acquiring MDROs in healthcare settings. The potential for cross transmission within the cohort and the possibility of colonized patients acquiring secondary isolates with additional antibiotic resistance traits is often neglected. We searched for evidence of cross transmission of KPC+ Klebsiella pneumoniae (KPC-Kp) colonization among cohorted patients in a long-term acute-care hospital (LTACH), and we evaluated the impact of secondary acquisitions on resistance potential. Genomic epidemiological investigation. A high-prevalence LTACH during a bundled intervention that included cohorting KPC-Kp-positive patients. Whole-genome sequencing (WGS) and location data were analyzed to identify potential cases of cross transmission between cohorted patients. Secondary KPC-Kp isolates from 19 of 28 admission-positive patients were more closely related to another patient's isolate than to their own admission isolate. Of these 19 cases, 14 showed strong genomic evidence for cross transmission (
ISSN:0899-823X
1559-6834
DOI:10.1017/ice.2020.261