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Transmission of Carbapenem-Resistant Klebsiella pneumoniae in US Hospitals.

Publication ,  Journal Article
Luterbach, CL; Chen, L; Komarow, L; Ostrowsky, B; Kaye, KS; Hanson, B; Arias, CA; Desai, S; Gallagher, JC; Novick, E; Pagkalinawan, S; Hill, C ...
Published in: Clin Infect Dis
January 13, 2023

BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKp) is the most prevalent carbapenem-resistant Enterobacterales in the United States. We evaluated CRKp clustering in patients in US hospitals. METHODS: From April 2016 to August 2017, 350 patients with clonal group 258 CRKp were enrolled in the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae, a prospective, multicenter, cohort study. A maximum likelihood tree was constructed using RAxML. Static clusters shared ≤21 single-nucleotide polymorphisms (SNP) and a most recent common ancestor. Dynamic clusters incorporated SNP distance, culture timing, and rates of SNP accumulation and transmission using the R program TransCluster. RESULTS: Most patients were admitted from home (n = 150, 43%) or long-term care facilities (n = 115, 33%). Urine (n = 149, 43%) was the most common isolation site. Overall, 55 static and 47 dynamics clusters were identified involving 210 of 350 (60%) and 194 of 350 (55%) patients, respectively. Approximately half of static clusters were identical to dynamic clusters. Static clusters consisted of 33 (60%) intrasystem and 22 (40%) intersystem clusters. Dynamic clusters consisted of 32 (68%) intrasystem and 15 (32%) intersystem clusters and had fewer SNP differences than static clusters (8 vs 9; P = .045; 95% confidence interval [CI]: -4 to 0). Dynamic intersystem clusters contained more patients than dynamic intrasystem clusters (median [interquartile range], 4 [2, 7] vs 2 [2, 2]; P = .007; 95% CI: -3 to 0). CONCLUSIONS: Widespread intrasystem and intersystem transmission of CRKp was identified in hospitalized US patients. Use of different methods for assessing genetic similarity resulted in only minor differences in interpretation.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

January 13, 2023

Volume

76

Issue

2

Start / End Page

229 / 237

Location

United States

Related Subject Headings

  • Prospective Studies
  • Microbiology
  • Klebsiella pneumoniae
  • Klebsiella Infections
  • Humans
  • Hospitals
  • Drug Resistance, Bacterial
  • Cohort Studies
  • Carbapenems
  • Carbapenem-Resistant Enterobacteriaceae
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Luterbach, C. L., Chen, L., Komarow, L., Ostrowsky, B., Kaye, K. S., Hanson, B., … Multi-Drug Resistant Organism Network Investigators Network Investigators and the Antibacterial Resistance Leadership Group, . (2023). Transmission of Carbapenem-Resistant Klebsiella pneumoniae in US Hospitals. Clin Infect Dis, 76(2), 229–237. https://doi.org/10.1093/cid/ciac791
Luterbach, Courtney L., Liang Chen, Lauren Komarow, Belinda Ostrowsky, Keith S. Kaye, Blake Hanson, Cesar A. Arias, et al. “Transmission of Carbapenem-Resistant Klebsiella pneumoniae in US Hospitals.Clin Infect Dis 76, no. 2 (January 13, 2023): 229–37. https://doi.org/10.1093/cid/ciac791.
Luterbach CL, Chen L, Komarow L, Ostrowsky B, Kaye KS, Hanson B, et al. Transmission of Carbapenem-Resistant Klebsiella pneumoniae in US Hospitals. Clin Infect Dis. 2023 Jan 13;76(2):229–37.
Luterbach, Courtney L., et al. “Transmission of Carbapenem-Resistant Klebsiella pneumoniae in US Hospitals.Clin Infect Dis, vol. 76, no. 2, Jan. 2023, pp. 229–37. Pubmed, doi:10.1093/cid/ciac791.
Luterbach CL, Chen L, Komarow L, Ostrowsky B, Kaye KS, Hanson B, Arias CA, Desai S, Gallagher JC, Novick E, Pagkalinawan S, Lautenbach E, Wortmann G, Kalayjian RC, Eilertson B, Farrell JJ, McCarty T, Hill C, Fowler VG, Kreiswirth BN, Bonomo RA, van Duin D, Multi-Drug Resistant Organism Network Investigators Network Investigators and the Antibacterial Resistance Leadership Group. Transmission of Carbapenem-Resistant Klebsiella pneumoniae in US Hospitals. Clin Infect Dis. 2023 Jan 13;76(2):229–237.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

January 13, 2023

Volume

76

Issue

2

Start / End Page

229 / 237

Location

United States

Related Subject Headings

  • Prospective Studies
  • Microbiology
  • Klebsiella pneumoniae
  • Klebsiella Infections
  • Humans
  • Hospitals
  • Drug Resistance, Bacterial
  • Cohort Studies
  • Carbapenems
  • Carbapenem-Resistant Enterobacteriaceae