Outbreak of Carbapenem-Resistant Enterobacteriaceae at a Long-Term Acute Care Hospital: Sustained Reductions in Transmission through Active Surveillance and Targeted Interventions

  title={Outbreak of Carbapenem-Resistant Enterobacteriaceae at a Long-Term Acute Care Hospital: Sustained Reductions in Transmission through Active Surveillance and Targeted Interventions},
  author={Amit S. Chitnis and Pam S Caruthers and Agam K. Rao and JoAnne Lamb and Robert Lurvey and Valery Madsen Beau De Rochars and Brandon Kitchel and Margarita R. Cancio and Thomas J. T{\"o}r{\"o}k and Alice Y Guh and Carolyn V. Gould and Matthew E. Wise},
  journal={Infection Control \&\#x0026; Hospital Epidemiology},
  pages={984 - 992}
Objective. To describe a Klebsiella pneumoniae carbapenemase (KPC)–producing carbapenem-resistant Enterobacteriaceae (CRE) outbreak and interventions to prevent transmission. Design, Setting, and Patients. Epidemiologic investigation of a CRE outbreak among patients at a long-term acute care hospital (LTACH). Methods. Microbiology records at LTACH A from March 2009 through February 2011 were reviewed to identify CRE transmission cases and cases admitted with CRE. CRE bacteremia episodes were… 

Epidemiology of Carbapenem-Resistant Enterobacteriaceae at a Long-term Acute Care Hospital

The majority of patients with CRE presented several days to weeks after LTACH admission, indicating possible organism acquisition in the LTACH itself, and the genetic similarity of the CRE isolates tested could further indicate the occurrence of horizontal transmission in theLTACH.

Success of a National Intervention in Controlling Carbapenem-resistant Enterobacteriaceae in Israel’s Long-term Care Facilities

A national, coordinated intervention resulted in a sustained decrease in CRE incidence and prevalence in LTCFs, and the assumption that centrally coordinated intervention is an essential public health tool in reducing CRE in healthcare facilities is supported.

Risk Factors for Colonization due to Carbapenem-Resistant Enterobacteriaceae among Patients: Exposed to Long-Term Acute Care and Acute Care Facilities

These results can be used to identify patients at increased risk for CRE colonization and to help target active surveillance programs in healthcare settings.

A National Intervention to Prevent the Spread of Carbapenem-Resistant Enterobacteriaceae in Israeli Post-Acute Care Hospitals

A nationwide infection control intervention was associated with enhanced infection control measures and a reduction in the prevalence of CRE in PACHs, indicating an important reservoir of antimicrobial-resistant bacteria.

Prevalence and Risk Factors for Acquisition of Carbapenem-Resistant Enterobacteriaceae in the Setting of Endemicity

Critical illness and underlying medical conditions, CRE colonization pressure, and antimicrobial exposure are important risk factors for CRE acquisition, and adherence to infection control practices and antimacterial stewardship appear to be critical components of a CRE control program.

Prevention of colonization and infection by Klebsiella pneumoniae carbapenemase-producing enterobacteriaceae in long-term acute-care hospitals.

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.

The Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Colonization and Infection among Long-Term Acute Care Hospital Residents

An improved understanding of carbapenem-resistant Klebsiella pneumoniae (CRKP) in long-term acute care hospitals (LTACHs) is needed, including targeted surveillance screening of high-risk patients and effective antibiotic stewardship measures.

Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore

The identification of risk factors amongst inpatients from an acute tertiary care hospital in Singapore helped to refine the criteria used for target active surveillance screening for CRE amongst inPatients at time of hospital admission.

Carbapenem-resistant Enterobacteriaceae (CRE) Case Definition Change: A Comparative Study of the Georgia Emerging Infections Program, 2011-2015 and 2016

CRE cases, following the new CRE case definition, had a 40% lower odds of invasive infections than that of the former, and the cause of this shift is unclear as more data is needed to assess the definition’s overall performance.



Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention.

  • M. SchwaberB. Lev Y. Carmeli
  • Medicine
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2011
A centrally coordinated intervention succeeded in containing a nationwide CRE outbreak after local measures failed and demonstrates the importance of strategic planning and national oversight in combating antimicrobial resistance.

Successful Control of an Outbreak of Klebsiella pneumoniae Carbapenemase—Producing K. pneumoniae at a Long-Term Acute Care Hospital

A bundled intervention was successful in preventing horizontal spread of KPC-producing gram-negative rods in a long-term acute care hospital, despite ongoing admission of patients colonized with KPC producers.

Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae.

Exposure network analysis and molecular epidemiologic methods were used to analyze the emergence and regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae over a 1-year period and observed extensive transfer of KPC-positive patients throughout the exposure network of 14 acute care hospitals, 2 LTACHs, and 10 nursing homes.

Carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae across a hospital system: impact of post-acute care facilities on dissemination.

The epidemiology and genetic basis of carbapenem resistance in A. baumannii and K. pneumoniae across a healthcare system is described and the important role post-acute care facilities play in the dissemination of multidrug-resistant phenotypes is illustrated.

Emergence of blaKPC-containing Klebsiella pneumoniae in a long-term acute care hospital: a new challenge to our healthcare system.

The detection of KPC-Kp in an LTACH represents a serious infection control and therapeutic challenge in a new clinical setting and the speed at which the epidemic is spreading in the healthcare system mandates urgent action.

Predictors of Carbapenem-Resistant Klebsiella pneumoniae Acquisition among Hospitalized Adults and Effect of Acquisition on Mortality

CRKP affects patients with poor functional status, an ICU stay, and antibiotic exposure and is an independent predictor of death.

Risk factors of carbapenem-resistant Klebsiella pneumoniae infections: a matched case control study.

The data suggest that prior exposure to fluoroquinolones and antipseudomonal penicillins are independent risk factors for the development of CRKp infections.

Clinical epidemiology of carbapenem-intermediate or -resistant Enterobacteriaceae.

A patient's cumulative antibiotic exposure history is likely to be more important than any one specific exposure when determining the likelihood of developing a CIRE infection.

Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium.

Carapenem-resistant K pneumoniae isolates are rapidly emerging in New York City and automated systems used for susceptibility testing may not accurately identify all these isolates, which will severely hamper control efforts.

Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities.

Infection with carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemase-producing Enterobacteriaceae is emerging as an important challenge in health-care settings. Currently,