Anatomic Sites of Patient Colonization and Environmental Contamination with Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae at Long-Term Acute Care Hospitals

作者：Thurlow Caroline J; Prabaker Kavitha; Lin Michael Y; Lolans Karen; Weinstein Robert A; Hayden Mary K^*

来源：Infection Control and Hospital Epidemiology, 2013, 34(1): 56-61.

DOI：10.1086/668783

OBJECTIVE. To determine anatomic sites of colonization in patients and to assess environmental contamination with Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae. %26lt;br%26gt;DESIGN, SETTING, AND PATIENTS. We conducted a cross-sectional microbiologic survey of 33 patients and their environments at 6 long-term acute care hospitals (LTACHs) in metropolitan Chicago. Swab samples of anatomic sites and inanimate surfaces in patients%26apos; rooms and common areas were cultured. bla(KPC) was verified by polymerase chain reaction. Patient charts were reviewed for covariates known to be associated with colonization and environmental contamination. %26lt;br%26gt;RESULTS. Mean age was 66 years. Median length of stay prior to surveillance was 50 days. Thirty (91%) patients were mechanically ventilated, 32 (97%) were bedbound, and 27 (82%) had fecal incontinence. Of the 24 patients with KPC-producing Enterobacteriaceae recovered from 1 or more anatomic sites, 23 (96%) had KPC-producing Enterobacteriaceae detected at 1 or more skin sites. Skin colonization was more common in patients with positive rectal/stool swab cultures or positive clinical cultures (P%26lt;.001). Rectal/stool swab was the single most sensitive specimen for detecting KPC-producing Enterobacteriaceae colonization (sensitivity, 88%; 95% confidence interval [CI], 68%-97%); addition of inguinal skin swab culture resulted in detection of all colonized patients (sensitivity, 100%; 95% CI, 86%-100%). Only 2 (0.5%) of 371 environmental specimens grew KPC-producing Enterobacteriaceae. %26lt;br%26gt;CONCLUSIONS. Culture of more than 1 anatomic site was required to detect all KPC-producing Enterobacteriaceae-colonized patients. Skin colonization was common, but environmental contamination was rare. These results can guide development of multimodal interventions for control of KPC-producing Enterobacteriaceae in LTACHs. Infect Control Hosp Epidemiol 2013;34(1):56-61

• 出版日期2013-1