Low Prevalence of KPC Producing Gram Negative Bacilli 3.18.09
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The study assessed screening for colonization with KPC-producing Gram-negative bacilli (KPC-GNB) using fecal swabs in patients at a 735-bed hospital with endemic KPC-GNB. Over 6 months, 258 fecal swabs were collected from consenting inpatients, but only 1 sample tested positive for KPC-GNB. Despite 138 patients having clinical cultures positive for KPC-GNB during the study, active surveillance cultures identified few carriers. The study suggests screening strategies relying on fecal swabs may not be effective for detecting KPC-GNB colonization and preventing transmission.
![Low Prevalence of KPC-producing Gram Negative Bacilli (KPC-GNB) among Fecal Swabs in a Large Tertiary Care Medical Center Leanne B. Gasink MD 1-4 , Irving Nachamkin DrPH, MPH 4,5 , Neil O. Fishman MD 1,4 , Baofeng Hu MD 3,5 , Pam Tolomeo MPC, CCRP 3 , Ebbing Lautenbach MD, MPH, MSCE 1-4 The Divisions of Infectious Diseases (1) of the Department of Medicine, Department of Pathology and Laboratory Medicine (5) , Department of Biostatistics and Epidemiology (2) Center for Clinical Epidemiology and Biostatistics (3) , Centers for Education and Research on Therapeutics (4) at the University of Pennsylvania School of Medicine, Philadelphia, PA MATERIALS AND METHODS ,[object Object],[object Object],[object Object],[object Object],INTRODUCTION DISCUSSION and CONCLUSIONS Background: The emergence of KPC-GNB is of great concern due to the limited therapeutic options and significant mortality associated with infection. Initially localized to specific geographical areas, KPC-GNB are rapidly spreading. Patient to patient transmission has been identified as a potential factor in the emergence of KPC-GNB. Given the relatively low prevalence of KPC-GNB at the current time, a “search and destroy” strategy, such as that successfully used to control the emergence of methicillin resistant Staphylococcus aureus in some European countries, has been suggested as a potentially useful strategy to prevent widespread dissemination of KPC-GNB. Universal active surveillance testing for colonization with drug resistant organisms is an essential component of a “search and destroy” approach so that colonized patients are identified early and appropriate isolation interventions can be implemented. Whether this strategy is feasible for the prevention of KPC-GNB is unknown. Objective : To assess the usefulness of screening for KPC-GNB colonization in a hospital with endemic KPC-GNB using fecal swabs. Methods: Between April 2007 and June 2008, quarterly fecal surveillance surveys were performed on consenting inpatients at a 735 bed adult academic tertiary and quaternary care medical center. Fecal swabs were used to inoculate MacConkey agar either containing ceftazidime or cefotaxime (1 ug/ml). Any isolates showing growth on screening agar were tested for carbapenem resistance using ertapenem disk diffusion. Carbapenem resistant isolates were identified and tested for the presence of KPC using polymerase chain reaction. All Escherichia coli and Klebsiella spp obtained in clinical isolates during this time period were also screened with ertapenem. Resistant clinical isolates underwent confirmatory KPC testing with polymerase chain reaction and/or the modified Hodge Test. Results: 258 fecal swabs were collected during the study period. Of these, 3 isolates were ertapenem resistant. KPC was identified in 1 Klebsiella pneumoniae isolate from an individual who was known to be clinically infected with a KPC producing K. pneumoniae prior to collection of the surveillance culture . During the study period, there were a total of 138 inpatients with clinical cultures positive for KPC-producing K. pneumoniae. Conclusions: Despite the presence of KPC-GNB encountered among clinical isolates, few KPC-GNB were identified in quarterly fecal surveillance cultures. As such, search and destroy strategies that depend on active surveillance may not be effective in preventing the spread of KPC-GNBs. However, future studies should evaluate alternate sampling strategies and the utility of active surveillance for KPC-GNB in a variety of settings. RESULTS POTENTIAL LIMITATIONS ABSTRACT RESULTS (continued) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Month of screen Number swabs collected KPC April-June 2007 99 0 July-September 2007 52 0 October-December 2007 4 0 April-June 2008 103 1 Total 258 1](https://image.slidesharecdn.com/lautenbachebbing-lowprevalenceofkpcproducinggramnegativebacilli-3-18-09-100819090741-phpapp01/85/Low-Prevalence-of-KPC-Producing-Gram-Negative-Bacilli-3-18-09-1-320.jpg)
