How Long-Term Acute Care Hospitals Can Play an Important Role in Controlling Carbapenem-Resistant Enterobacteriaceae in a Region: A Simulation Modeling Study

Lee, Bruce Y.; Bartsch, Sarah M.; Lin, Michael; Asti, Lindsey; Welling, Joel; Mueller, Leslie E.; Leonard, Jim; Brown, Shawn T.; Doshi, Kruti; Kemble, Sarah K.; Mitgang, Elizabeth; Weinstein, Robert A.; Trick, William; Hayden, Mary K

doi:10.1093/aje/kwaa247

Cited by 9 publications

(3 citation statements)

References 41 publications

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“…spread. [20][21][22][23][24] Thus, these sustained efforts at LTACH-A may provide considerable benefits to the broader region.…”

Section: Discussionmentioning

confidence: 99%

Concurrent transmission of multiple carbapenemases in a long-term acute-care hospital

Rankin,

Walters,

Caicedo

et al. 2024

Infect. Control Hosp. Epidemiol.

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Objective: We investigated concurrent outbreaks of Pseudomonas aeruginosa carrying blaVIM (VIM-CRPA) and Enterobacterales carrying blaKPC (KPC-CRE) at a long-term acute-care hospital (LTACH A). Methods: We defined an incident case as the first detection of blaKPC or blaVIM from a patient’s clinical cultures or colonization screening test. We reviewed medical records and performed infection control assessments, colonization screening, environmental sampling, and molecular characterization of carbapenemase-producing organisms from clinical and environmental sources by pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing. Results: From July 2017 to December 2018, 76 incident cases were identified from 69 case patients: 51 had blaKPC, 11 had blaVIM, and 7 had blaVIM and blaKPC. Also, blaKPC were identified from 7 Enterobacterales, and all blaVIM were P. aeruginosa. We observed gaps in hand hygiene, and we recovered KPC-CRE and VIM-CRPA from drains and toilets. We identified 4 KPC alleles and 2 VIM alleles; 2 KPC alleles were located on plasmids that were identified across multiple Enterobacterales and in both clinical and environmental isolates. Conclusions: Our response to a single patient colonized with VIM-CRPA and KPC-CRE identified concurrent CPO outbreaks at LTACH A. Epidemiologic and genomic investigations indicated that the observed diversity was due to a combination of multiple introductions of VIM-CRPA and KPC-CRE and to the transfer of carbapenemase genes across different bacteria species and strains. Improved infection control, including interventions that minimized potential spread from wastewater premise plumbing, stopped transmission.

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“…spread. [20][21][22][23][24] Thus, these sustained efforts at LTACH-A may provide considerable benefits to the broader region.…”

Section: Discussionmentioning

confidence: 99%

Concurrent transmission of multiple carbapenemases in a long-term acute-care hospital

Rankin,

Walters,

Caicedo

et al. 2024

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

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“…Patients in these facilities have been shown to be colonized with CRE at high rates, likely due to a combination of their chronic severe illness, long lengths of stay, and high rates of prior or on-going antibiotic exposure. Modeling and epidemiologic studies have suggested that the high CRE prevalence in LTACHs in particular has a significant impact on connected healthcare facilities with which they share patients [7,8]. Currently, less is known about the regional influence of vSNFs, although the even longer lengths of patient stay and more limited resources for infection prevention indicate that they might also be important settings in regional amplification of antibiotic resistance.…”

Section: Introductionmentioning

confidence: 99%

Regional spread of bla_NDM-1-containing Klebsiella pneumoniae Sequence Type 147 in post-acute care facilities

Lapp

Crawford

Miles-Jay

et al. 2021

Preprint

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Background Carbapenem-resistant Enterobacterales (CRE) harboring blaKPC have been endemic in Chicago-area healthcare networks for more than a decade. During 2016-2019, a series of regional point prevalence surveys identified increasing prevalence of blaNDM-containing CRE in multiple long-term acute care hospitals (LTACHs) and ventilator-capable skilled nursing facilities (vSNFs). We performed a genomic epidemiology investigation of blaNDM-producing CRE to understand their regional emergence and spread. Methods We performed whole-genome sequencing on NDM+ CRE isolates from four point-prevalence surveys across 35 facilities (LTACHs, vSNFs, and acute care hospital medical intensive care units) in the Chicago area and investigated the genomic relatedness and transmission dynamics of these isolates over time. Results Genomic analyses revealed that the rise of NDM+ CRE was due to the clonal dissemination of an ST147 Klebsiella pneumoniae strain harboring blaNDM-1 on an IncF plasmid. Dated phylogenetic reconstructions indicated that ST147 was introduced into the region around 2013 and likely acquired NDM around 2015. Analyzing genomic data in the context of patient transfer networks supported initial increases in prevalence due to intra-facility transmission in certain vSNFs, with evidence of subsequent inter-facility spread to connected LTACHs and vSNFs via patient transfer. Conclusions We identified a regional outbreak of blaNDM-1 ST147 that began in and disseminated across Chicago area post-acute care facilities. Our findings highlight the importance of performing genomic surveillance at post-acute care facilities to identify emerging threats.

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“…Patients in these facilities have been shown to be colonized with CRE at high rates, likely due to a combination of their chronic severe illness, long lengths of stay, and high rates of prior or ongoing antibiotic exposure. Modeling and epidemiologic studies have suggested that the high CRE prevalence in LTACHs in particular has a significant impact on connected healthcare facilities with which they share patients [ 7 , 8 ]. Currently, less is known about the regional influence of vSNFs, although the even longer lengths of patient stay and more limited resources for infection prevention indicate that they might also be important settings in regional amplification of antibiotic resistance.…”

mentioning

confidence: 99%

Regional Spread of blaNDM-1-Containing Klebsiella pneumoniae ST147 in Post-Acute Care Facilities

Lapp

Crawford

Miles-Jay

et al. 2021

Clinical Infectious Diseases

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Background Carbapenem-resistant Enterobacterales (CRE) harboring blaKPC have been endemic in Chicago-area healthcare networks for more than a decade. During 2016-2019, a series of regional point prevalence surveys identified increasing prevalence of blaNDM-containing CRE in multiple long-term acute care hospitals (LTACHs) and ventilator-capable skilled nursing facilities (vSNFs). We performed a genomic epidemiology investigation of blaNDM-producing CRE to understand their regional emergence and spread. Methods We performed whole-genome sequencing on NDM+ CRE isolates from four point-prevalence surveys across 35 facilities (LTACHs, vSNFs, and acute care hospital medical intensive care units) in the Chicago area and investigated the genomic relatedness and transmission dynamics of these isolates over time. Results Genomic analyses revealed that the rise of NDM+ CRE was due to the clonal dissemination of an ST147 Klebsiella pneumoniae strain harboring blaNDM-1 on an IncF plasmid. Dated phylogenetic reconstructions indicated that ST147 was introduced into the region around 2013 and likely acquired NDM around 2015. Analyzing the relatedness of strains within and between facilities supported initial increases in prevalence due to intra-facility transmission in certain vSNFs, with evidence of subsequent inter-facility spread among LTACHs and vSNFs connected by patient transfer. Conclusions We identified a regional outbreak of blaNDM-1 ST147 that began in and disseminated across Chicago area post-acute care facilities. Our findings highlight the importance of performing genomic surveillance at post-acute care facilities to identify emerging threats.

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How Long-Term Acute Care Hospitals Can Play an Important Role in Controlling Carbapenem-Resistant Enterobacteriaceae in a Region: A Simulation Modeling Study

Cited by 9 publications

References 41 publications

Concurrent transmission of multiple carbapenemases in a long-term acute-care hospital

Concurrent transmission of multiple carbapenemases in a long-term acute-care hospital

Regional spread of bla_NDM-1-containing Klebsiella pneumoniae Sequence Type 147 in post-acute care facilities

Regional Spread of blaNDM-1-Containing Klebsiella pneumoniae ST147 in Post-Acute Care Facilities

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How Long-Term Acute Care Hospitals Can Play an Important Role in Controlling Carbapenem-Resistant Enterobacteriaceae in a Region: A Simulation Modeling Study

Cited by 9 publications

References 41 publications

Concurrent transmission of multiple carbapenemases in a long-term acute-care hospital

Concurrent transmission of multiple carbapenemases in a long-term acute-care hospital

Regional spread of blaNDM-1-containing Klebsiella pneumoniae Sequence Type 147 in post-acute care facilities

Regional Spread of blaNDM-1-Containing Klebsiella pneumoniae ST147 in Post-Acute Care Facilities

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Product

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Regional spread of bla_NDM-1-containing Klebsiella pneumoniae Sequence Type 147 in post-acute care facilities