Hunter Holmes McGuire Veterans Affairs Medical Center, Virginia Commonwealth University, Division of Infectious Diseases, Richmond, Virginia, USA.
Clin Infect Dis. 2011 Sep;53(6):532-40. doi: 10.1093/cid/cir482.
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. Although 40 patients and 26 health care facilities were affected, 1 long-term acute care hospital played a critical role in the convergence of patients at high risk, amplification by cross-infection, and dissemination of these multidrug-resistant bacteria.
Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae are an emerging antibiotic resistance threat with demonstrated epidemic potential.
We conducted an outbreak investigation of KPC-producing Enterobacteriaceae among patients of acute and long-term acute care hospitals (LTACHs) in 4 adjacent counties in Indiana and Illinois from 1 January 2008 through 31 December 2008 (cases). The study used traditional and molecular epidemiologic methods and an adaptation of social network analysis ("exposure network analysis").
Clinical records for 40 (95%) of 42 patients were available. Patients were mostly older with multiple comorbid conditions. Eleven patients (27.5%) died during the index hospitalization or were discharged to hospice; 23 (57.5%) were discharged to a nursing home, and 4 (10.0%) were discharged to home. One LTACH (LTACH-A) was central to the regional outbreak: 24 (60%) of 40 cases were linked to LTACH-A, and at least 10 patients (25%) acquired KPC there. Of 16 cases not linked to LTACH-A, 12 (75%) were linked to 3 nursing homes. Only 4 patients (10%) definitely acquired KPC during an acute care hospital stay. Molecular typing revealed the 31 available KPC-positive K. pneumoniae isolates to be similar and to cluster with epidemic multilocus sequence type 258; 2 KPC-positive Escherichia coli isolates were unique.
We observed extensive transfer of KPC-positive patients throughout the exposure network of 14 acute care hospitals, 2 LTACHs, and 10 nursing homes. Although few cases were identified at most institutions, many facilities were affected. Successful control of KPC-producing Enterobacteriaceae will require a coordinated, regional effort among acute and long-term health care facilities and public health departments.
使用暴露网络分析和分子流行病学方法，分析了产碳青霉烯酶肠杆菌科细菌在 1 年内的出现和区域传播。尽管有 40 名患者和 26 个医疗机构受到影响，但 1 家长期急性护理医院在高危患者的聚集、交叉感染的放大以及这些多药耐药菌的传播方面发挥了关键作用。
产碳青霉烯酶肠杆菌科细菌（KPC）是一种新兴的抗生素耐药威胁，具有明显的流行潜力。
我们对印第安纳州和伊利诺伊州 4 个毗邻县的急性和长期急性护理医院（LTACH）的产碳青霉烯酶肠杆菌科患者进行了暴发调查，时间为 2008 年 1 月 1 日至 2008 年 12 月 31 日（病例）。研究采用了传统和分子流行病学方法以及社会网络分析（“暴露网络分析”）的改编。
可获得 42 名患者中的 40 名（95%）的临床记录。患者年龄较大，合并多种疾病。11 名患者（27.5%）在指数住院期间死亡或出院至临终关怀；23 名（57.5%）出院至疗养院，4 名（10.0%）出院至家庭。1 家 LTACH（LTACH-A）是区域暴发的中心：40 例病例中有 24 例（60%）与 LTACH-A 有关，至少有 10 名患者（25%）在那里获得了 KPC。在 16 例未与 LTACH-A 相关的病例中，有 12 例（75%）与 3 家疗养院有关。只有 4 名患者（10%）在急性住院期间肯定获得了 KPC。分子分型显示 31 株可获得的产碳青霉烯酶肺炎克雷伯菌分离株相似，并与流行的多位点序列型 258 聚类；2 株产碳青霉烯酶大肠埃希菌分离株是独特的。
我们观察到大量产碳青霉烯酶阳性患者在 14 家急性护理医院、2 家 LTACH 和 10 家疗养院的暴露网络中转移。尽管大多数机构只发现了少数病例，但许多机构都受到了影响。成功控制产碳青霉烯酶肠杆菌科细菌需要急性和长期医疗保健机构以及公共卫生部门之间的协调、区域努力。
