Researchers with the Los Angeles County Department of Public Health have found high rates of the multi-drug resistant pathogen, carbapenem-resistant Klebsiella pneumoniae (CRKP) among the patient population in long-term acute care hospitals compared to general acute care hospitals across the county. These findings are particularly important because CRKP was thought to be contained to East Coast facilities and communities. These findings will be presented at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA) on April 3 in Dallas.
CRKP is resistant to nearly all antibiotic options and has been associated with higher mortality, longer hospital stays and increased health care costs. Because CRKP was thought to be rare in Los Angeles County, though actual numbers were unknown, Dawn Terashita, MD, MPH, Medical Epidemiologist and colleagues, with the county's Department of Public Health sought to establish a surveillance system to monitor its existence in the county.
After declaring CRKP a laboratory-reportable disease, meaning that its appearance must be reported by a laboratory if found during testing, Terashita's team noted unexpectedly high numbers of CRKP across the county. During the study period of June 2010 to December 2010, 350 cases of CRKP were identified. Many of the cases, 42 percent, occurred in long-term acute care hospitals, and 6 percent were found in patients residing in skilled nursing facilities.
"This study does not go as far as addressing why we are seeing these high rates. We do not know if the presence of CRKP in these long-term acute care settings is the result of improper care, or has more to do with the population they serve. These patients tend to be elderly, they are commonly on ventilators and they often stay at the facility for an extended period of time. They tend to have many health problems and are often placed on antibiotics which may or may not be appropriate. All of these factors contribute to a greater risk for health care acquired infections," Terashita says.
Terashita underscored the need to monitor the development of emerging pathogens such as CRKP more closely in healthcare facilities including long-term acute care facilities.
"If we want to stop resistant bacteria in their tracks, we have to know where to begin," says Arjun Srinivasan, MD, associate director of healthcare-associated infection prevention programs at the Centers for Disease Control and Prevention (CDC). "These findings demonstrate the vital need to monitor drug-resistant bacteria and highlight the important and growing role that state and local health departments are playing in helping monitor and prevent healthcare-associated infections."