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Modeling Spread of KPC-Producing Bacteria in Long-Term Acute Care Hospitals in the Chicago Region, USA

Published online by Cambridge University Press:  24 July 2015

Manon R. Haverkate ,
Martin C. J. Bootsma ,
Shayna Weiner ,
Donald Blom ,
Michael Y. Lin ,
Karen Lolans ,
Nicholas M. Moore ,
Rosie D. Lyles ,
Robert A. Weinstein  and
Marc J. M. Bonten
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Manon R. Haverkate*
Affiliation:
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Department of Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States
Martin C. J. Bootsma
Affiliation:
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Department of Mathematics, Utrecht University, Utrecht, The Netherlands
Shayna Weiner
Affiliation:
Department of Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States
Donald Blom
Affiliation:
Department of Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States
Michael Y. Lin
Affiliation:
Department of Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States
Karen Lolans
Affiliation:
Department of Pathology, Rush University Medical Center, Chicago, Illinois, United States
Nicholas M. Moore
Affiliation:
Department of Medical Laboratory Science, Rush University Medical Center, Chicago, Illinois, United States
Rosie D. Lyles
Affiliation:
Department of Medicine, Division of Infectious Diseases, Cook County Health and Hospital System, Chicago, Illinois, United States
Robert A. Weinstein
Affiliation:
Department of Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States Department of Medicine, Division of Infectious Diseases, Cook County Health and Hospital System, Chicago, Illinois, United States
Marc J. M. Bonten
Affiliation:
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
Mary K. Hayden
Affiliation:
Department of Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States Department of Pathology, Rush University Medical Center, Chicago, Illinois, United States
*
Address correspondence to Manon R. Haverkate, Huispostnummer Geuns 5.02, Heidelberglaan 100, 3584 CK Utrecht (m.r.haverkate-2@umcutrecht.nl).
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Abstract

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Supplement 10 , October 2015 , pp. 1148 - 1154
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Preliminary results from this study were presented at IDWeek 2014; October 8–12, 2014, Philadelphia, Pennsylvania, USA.

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