Carbapenem-Resistant Klebsiella pneumoniae Associated with a Long-Term— Care Facility — West Virginia, 2009–2011

• Published in: MMWR. Morbidity and mortality weekly report 2011-10, Vol.60 (41), p.1418-1420
• Main Authors: Gaviria, Diana, Greenfield, Victoria, Bixler, Danae, Thomas, Carrie A, Ibrahim, Sherif M, Kallen, Alex, Limbago, Brandi, Kitchel, Brandon, Taylor, Tegwin K
• Format: Article
• Language: English
• Subjects: Aged; Anti-Bacterial Agents - pharmacology; Antimicrobials; Bacterial pneumonia; Carbenicillin - pharmacology; Case-Control Studies; Cross infection; Disease Outbreaks; Electrophoresis, Gel, Pulsed-Field; Female; Health aspects; Hospital admissions; Hospital units; Humans; Infection Control; Infections; Klebsiella Infections - drug therapy; Klebsiella Infections - epidemiology; Klebsiella pneumoniae; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - genetics; Klebsiella pneumoniae - isolation & purification; Long-Term Care; Long-term care of the sick; Male; Medical research; Medicine, Experimental; Mortality; Nosocomial infections; Penicillin Resistance; Pneumonia; Population Surveillance; Predisposing factors; Public health; Risk Factors; Surveillance; West Virginia - epidemiology
• ISSN: 0149-2195; 1545-861X

On January 27, 2011, a West Virginia county health department was notified of a cluster of carbapenem-resistant Klebsiella pneumoniae (CRKP) cases detected by a local hospital (hospital A). CRKP infections frequently are resistant to a majority of antimicrobial agents and have an increased risk for morbidity and mortality. The West Virginia Bureau for Public Health (WVBPH) conducted field investigations to identify all cases, characterize risk factors for infection, and abstract data for a matched case-control study. Nineteen case-patients and 38 control patients were identified. Infection with CRKP was associated with admission from or prior stay at a local long-term--care facility (LTCF A). Pulsed-field gel electrophoresis (PFGE) analysis indicated that all five hospital A clinical specimens and all 11 point prevalence survey isolates from LTCF A were closely related. This is the first outbreak of CRKP identified in West Virginia. Recommendations to LTCF A included the following: 1) initiate surveillance for multidrug resistant organisms; 2) revise and improve infection prevention and control activities within the facility; 3) educate residents and their families, physicians, and staff members about CRKP; and 4) identify qualified personnel to coordinate infection control functions within the facility. Although LTCF A has made significant improvements, the outbreak investigation is ongoing. Additional site visits have been conducted, and additional colonized residents have been identified; the last clinical case was detected in July. These findings demonstrate the interconnectedness of the health-care system and factors potentially contributing to transmission of infection. Interventions targeting all levels of care are needed to prevent further CRKP transmission.