The Rate of Acquisition of Carbapenemase-Producing Enterobacteriaceae among Close Contact Patients Depending on Carbapenemase Enzymes
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Background: Carbapenemase-producing Enterobacteriaceae (CPE) are highly drug-resistant pathogens. Screening the contacts of newly-identified CPE patients is crucial for nosocomial transmission control. We evaluated the acquisition rate of CPE in close contacts as a function of CPE genotype. Materials and Methods: This study was conducted in Asan Medical Center, a 2,700-bed, tertiary teaching hospital in Seoul, Korea, between November 2010 and October 2017. Index cases were defined as patients with positive tests for CPE from any infected or colonized site during hospitalization who had no direct epidemiologic linkage with existing CPE patients; close contact patients were defined as those whose hospital stay overlapped with the stay of an index case for at least one day and who occupied the same room or intensive care unit (ICU). Secondary patients were defined as those who produced positive CPE culture isolates from surveillance cultures that had the same CPE enzyme as that of the index case patients. Results: A total of 211 index case patients and 2,689 corresponding contact patients were identified. Of the contact patients, 1,369 (50.9%) including 649 New-Delhi metallo-betalactamase-1 (NDM-1) and 448 Klebsiella pneumoniae carbapenemase (KPC)-producing CPE exposures were screened, and 44 secondary patients (3.2%; 95% confidence interval 2.3 - 4.3%) were positive for NDM-1-producing CPE (16 patients) and KPC-producing (24 patients) CPE. The CPE acquisition rate (5.4%) for KPC-producing CPE exposures was significantly higher than that for NDM-1 exposures (2.7%) (P = 0.01). Conclusion: The CPE acquisition rate was 3.2% among close contacts sharing a multi-patient room, with about a two-fold higher risk of KPC-producing CPE than NDM-1-producing CPE.
Abstract
Background: Carbapenemase-producing Enterobacteriaceae (CPE) are highly drug-resistant pathogens. Screening the contacts of newly-identified CPE patients is crucial for nosocomial transmission control. We evaluated the acquisition rate of CPE in close contacts as a function of CPE genotype. Materials and Methods: This study was conducted in Asan Medical Center, a 2,700-bed, tertiary teaching hospital in Seoul, Korea, between November 2010 and October 2017. Index cases were defined as patients with positive tests for CPE from any infected or colonized site during hospitalization who had no direct epidemiologic linkage with existing CPE patients; close contact patients were defined as those whose hospital stay overlapped with the stay of an index case for at least one day and who occupied the same room or intensive care unit (ICU). Secondary patients were defined as those who produced positive CPE culture isolates from surveillance cultures that had the same CPE enzyme as that of the index case patients. Results: A total of 211 index case patients and 2,689 corresponding contact patients were identified. Of the contact patients, 1,369 (50.9%) including 649 New-Delhi metallo-betalactamase-1 (NDM-1) and 448 Klebsiella pneumoniae carbapenemase (KPC)-producing CPE exposures were screened, and 44 secondary patients (3.2%; 95% confidence interval 2.3 - 4.3%) were positive for NDM-1-producing CPE (16 patients) and KPC-producing (24 patients) CPE. The CPE acquisition rate (5.4%) for KPC-producing CPE exposures was significantly higher than that for NDM-1 exposures (2.7%) (P = 0.01). Conclusion: The CPE acquisition rate was 3.2% among close contacts sharing a multi-patient room, with about a two-fold higher risk of KPC-producing CPE than NDM-1-producing CPE.
참고문헌 (14)
- Logan LK, "The epidemiology of carbapenem-resistant Enterobacteriaceae: the impact and evolution of a global menace", J Infect Dis, 215(suppl_1), pp.S28~S36 (2017)
- Peleg AY, "Hospital-acquired infections due to gram-negative bacteria", N Engl J Med, 362, pp.1804~1813 (2010)
- Marston HD, "Antimicrobial resistance", JAMA, 316, pp.1193~1204 (2016)
- Nordmann P, "The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria", Lancet Infect Dis, 9, pp.228~236 (2009)
- Lee E, "Analysis of carbapenemase-producing Enterobacteriaceae(CPE)surveillance results for 2017 in Korea : Comparison with the surveillance results of the previous 5 years(2012-2016)", PHWR, 11, pp.1586~1594 (2018)
- Cardoso T, "Classification of healthcare-associated infection : a systematic review 10 years after the first proposal", BMC Med, 12, pp.40~ (2014)
- Korean Society for Healthcare-associated Infection Control and Prevention (KOSHIC), "Korean national healthcare-associated infections surveillance system manual", ~ (2018)
- Clinical and Laboratory Standards Institute (CLSI), "Performance standards for antimicrobial susceptibility testing: M100. 27th ed", CLSI, ~ (2017)
- Podschun R, "Klebsiella spp. as nosocomial pathogens : epidemiology, taxonomy, typing methods, and pathogenicity factors", Clin Microbiol Rev, 11, pp.589~603 (1998)
- Lerner A, "Spread of KPC-producing carbapenem-resistant Enterobacteriaceae : the importance of super-spreaders and rectal KPC concentration", Clin Microbiol Infect, 21, pp.470.e1~470.e7 (2015)
- Lim YJ, "Clearance of carbapenemase-producing Enterobacteriaceae(CPE)carriage : a comparative study of NDM-1 and KPC CPE", Clin Microbiol Infect, 24, pp.1104.e5~1104.e8 (2018)
- Walsh TR, "Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health : an environmental point prevalence study", Lancet Infect Dis, 11, pp.355~362 (2011)
- Seara N, "Interhospital spread of NDM-7-producing Klebsiella pneumoniae belonging to ST437 in Spain", Int J Antimicrob Agents, 46, pp.169~173 (2015)
- Schwartz-Neiderman A, "Risk factors for carbapenemase-producing carbapenem-resistant Enterobacteriaceae(CP-CRE)acquisition among contacts of newly diagnosed CP-CRE patients", Infect Control Hosp Epidemiol, 37, pp.1219~1225 (2016)