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

Jung Wan Park; Sun Hee Kwak; Jiwon Jung; Jeong Young Lee; Young Ju Lim; Hye Suk Choi; Min Jee Hong; Sang Ho Choi; Mi Na Kim; Sung Han Kim

doi:10.3947/ic.2020.52.1.39

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

Infect Chemother. 2020 Mar;52(1):39-47. doi: 10.3947/ic.2020.52.1.39. Epub 2020 Feb 20.

Authors

Jung Wan Park^#^{1

2}, Sun Hee Kwak^#³, Jiwon Jung^{1

3}, Jeong Young Lee³, Young Ju Lim³, Hye Suk Choi³, Min Jee Hong³, Sang Ho Choi^{1

3}, Mi Na Kim^{1

4}, Sung Han Kim^{1

5}

Affiliations

¹ Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
² Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheoan, Korea.
³ Office for Infection Control, Asan Medical Center, Seoul, Korea.
⁴ Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
⁵ Office for Infection Control, Asan Medical Center, Seoul, Korea. kimsunghanmd@hotmail.com.

^# Contributed equally.

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-beta-lactamase-1 (NDM-1) and 448 Klebsiella pneumoniae carbapenemase (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.

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

Grants and funding

HI15C1763/MHW/Ministry of Health and Welfare/Korea