Infect Chemother.  2020 Mar;52(1):39-47. 10.3947/ic.2020.52.1.39.

The Rate of Acquisition of Carbapenemase-Producing Enterobacteriaceae among Close Contact Patients Depending on Carbapenemase Enzymes

• Park JW
• Kwak SH
• Jung J
• Lee JY
• Lim YJ
• Choi HS
• Hong MJ
• Choi SH
• Kim MN
• Kim SH

• KMID: 2507322
• DOI: http://doi.org/10.3947/ic.2020.52.1.39

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 carbaepenamse (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.

Keyword

Carpapenemase-producing Enterobacteriaceae; Acquisition rate; Klebsiella pneumoniae carbaepenamse; New Delhi Metallo-beta-lactamase-1

Figure

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  Figure 1 Flow chart of the Study.CPE, Carbapenemase producing Enterobacteriaceae; KPC, Klebsiella pneumoniae carbapenemase; NDM-1, New Delhi metallo- beta-lactamase; VIM, verona integron-encoded metallo-beta-lactamase; OXA, oxacillin carbapenemase.

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