Carbapenem-resistant Klebsiella pneumoniae in post-acute-care facilities in Israel

Objective. To assess the prevalence of and risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) carriage among patients in post-acute-care facilities (PACFs) in Israel. Design, setting, and patients. A cross-sectional prevalence survey was conducted in 12 PACFs. Rectal swab samples were obtained from 1,144 patients in 33 wards. Risk factors for CRKP carriage were assessed among the cohort. Next, a nested, matched case-control study was conducted to define individual risk factors for colonization. Finally, the cohort of patients with a history of CRKP carriage was characterized to determine risk factors for continuous carriage. Results. The prevalence of rectal carriage of CRKP among 1,004 patients without a history of CRKP carriage was 12.0%. Independent risk factors for CRKP carriage were prolonged length of stay (odds ratio [OR], 1.001; P <.001), sharing a room with a known carrier (OR, 3.09; Pp.02), and increased prevalence of known carriers on the ward (OR, 1.02; Pp.013). A policy of screening for carriage on admission was protective (OR, 0.41; Pp.03). Risk factors identified in the nested case-control study were antibiotic exposure during the prior 3 months (OR, 1.66; Pp.03) and colonization with other resistant pathogens (OR, 1.64; Pp.03). Among 140 patients with a history of CRKP carriage, 47% were colonized. Independent risk factors for continued CRKP carriage were antibiotic exposure during the prior 3 months (OR, 3.05; Pp.04), receipt of amoxicillin-clavulanate (OR, 4.18; Pp.007), and screening within 90 days of the first culture growing CRKP (OR, 2.9; Pp.012). Conclusions. We found a large reservoir of CRKP in PACFs. Infection-control polices and antibiotic exposure were associated with patient colonization.