Prevention of Colonization and Infection by Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae in Long Term Acute Care Hospitals.

Background. Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (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 KPCpositive 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 four LTACHs with high endemic KPC prevalence. The study was conducted between February 1, 2010-June 30, 2013; 3,894 patients were enrolled during pre-intervention (16-29 months) and 2,951 patients were enrolled during intervention (12-19 months).

RESULTS: KPC colonization prevalence was stable during pre-intervention (average, 45.8%; 95% CI 42.1-49.5%), declined early during intervention, then reached a plateau (34.3%; 95% CI 32.4%-36.2%; p<0.001 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/100 patient-weeks (p=0.004 for linear decline). Compared to pre-intervention, average rates of clinical outcomes declined during intervention: KPC in any clinical culture (3.7 to 2.5/1000 patient-days, p=0.001), KPC bacteremia (0.9 to 0.4/1000 patient-days, p=0.008), all-cause bacteremia (11.2 to 7.6/1000 patient-days, p=0.006) and blood culture contamination (4.9 to 2.3/1000 patient-days, p=0.03).

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.

Prevention of Colonization and Infection by Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae in Long Term Acute Care Hospitals. Hayden MK, Lin MY, Lolans K, et al Clin Infect Dis. 2014 Dec 23. pii: ciu1173. [Epub ahead of print]

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