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Carbapenem-Resistant Klebsiella pneumoniae in Post-Acute-Care Facilities in Israel

Published online by Cambridge University Press:  02 January 2015

Debby Ben-David ,
Samira Masarwa ,
Shiri Navon-Venezia ,
Hagit Mishali ,
Ilan Fridental ,
Bina Rubinovitch ,
Gill Smollan ,
Yehuda Carmeli ,
Mitchell J. Schwaber  and
Israel PACF CRKP (Post-Acute-Care Facility Carbapenem-Resistant Klebsiella pneumoniae) Working Group
Debby Ben-David*
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Samira Masarwa
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Shiri Navon-Venezia
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Hagit Mishali
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Ilan Fridental
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Bina Rubinovitch
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Gill Smollan
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Yehuda Carmeli
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Mitchell J. Schwaber
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Israel PACF CRKP (Post-Acute-Care Facility Carbapenem-Resistant Klebsiella pneumoniae) Working Group
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
*
National Center for Infection Control, 6 Weizmann Street, Tel Aviv 64239, Israel (debby.bendavid@sheba.health.gov.il)
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Abstract

Objective.

To assess the prevalence of and risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) carriage among patients in post-acute-care facilities (PACFs) in Israel.

Design, Setting, and Patients.

A cross-sectional prevalence survey was conducted in 12 PACFs. Rectal swab samples were obtained from 1,144 patients in 33 wards. Risk factors for CRKP carriage were assessed among the cohort. Next, a nested, matched case-control study was conducted to define individual risk factors for colonization. Finally, the cohort of patients with a history of CRKP carriage was characterized to determine risk factors for continuous carriage.

Results.

The prevalence of rectal carriage of CRKP among 1,004 patients without a history of CRKP carriage was 12.0%. Independent risk factors for CRKP carriage were prolonged length of stay (odds ratio [OR], 1.001; P < .001), sharing a room with a known carrier (OR, 3.09; P = .02), and increased prevalence of known carriers on the ward (OR, 1.02; P = .013). A policy of screening for carriage on admission was protective (OR, 0.41; P = .03). Risk factors identified in the nested case-control study were antibiotic exposure during the prior 3 months (OR, 1.66; P = .03) and colonization with other resistant pathogens (OR, 1.64; P = .03). Among 140 patients with a history of CRKP carriage, 47% were colonized. Independent risk factors for continued CRKP carriage were antibiotic exposure during the prior 3 months (OR, 3.05; P = .04), receipt of amoxicillin-clavulanate (OR, 4.18; P = .007), and screening within 90 days of the first culture growing CRKP (OR, 2.9; P = .012).

Conclusions.

We found a large reservoir of CRKP in PACFs. Infection-control polices and antibiotic exposure were associated with patient colonization.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 9 , September 2011 , pp. 845 - 853
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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