Table 1.
Characteristics of Case Patients with Carbapenemase-Producing Organisms, by Carbapenemase Gene Detected at Long-Term Acute-Care Hospital-A, Florida, July 2017–December 2018 a
| Characteristics | All CPOs (n=61), No. (%) b |
bla
VIM, only (n=9), No. (%) b |
bla
VIM and bla
KPC (n=6), No. (%) b,c |
bla
KPC, only (n=46), No. (%) b,d |
P Value e |
|---|---|---|---|---|---|
| Sex, male | 34 (56) | 7 (78) | 2 (33) | 25 (54) | .220 |
| Age, median y (IQR) | 66 (56–73) | 60 (42–72) | 67 (64–72) | 66 (56–73) | .790 |
| LOS median d (IQR) | 48 (28–77) | 41 (28–57) | 82 (42–89) | 47 (27–73) | .857 |
| ICU stay before incident specimen | 22 (36) | 3 (33) | 4 (67) | 15 (33) | .259 |
| Duration to incident specimen, median d (IQR) | 34 (20–52) | 20 (14–27) | 33 (21–48) | 36 (24–57) | .135 |
| Specimen type of incident case | |||||
| Rectal screening | 53 (87) | 7 (78) | 4 (67) | 42 (91) | .166 |
| Clinical isolate | 8 (13) f | 2 (18) | 2 (33) | 4 (8) | |
| Epidemiologic classification | |||||
| Met criteria for LTACH-A acquired a | 40 (66) | 2 (22) | 5 (83) | 33 (72) | .011 h |
| Unable to determine if LTACH-A acquired g | 21 (34) | 7 (78) | 1 (17) | 13 (28) | |
| Death, <90 d incident specimen | 20 (33) | 4 (44) | 4 (67) | 12 (26) | .103 i |
| LOS, from first-positive to death, median d (IQR) | 33 (16–60) | 41 (34–58) | 20 (8–45) | 28 (16–65) | .614 |
| Charlson comorbidity score, median (IQR) | 3 (1–5) j | 3 (0–5) | 6 (5–8) | 3 (2–4) k | .014 h,i |
| No Charlson comorbidities k | 5 (8) | 3 (33) | 0 | 2 (4) | .006 |
| 5 Most common Charlson comorbidities | |||||
| Diabetes | 31 (65) j | 3 (33) | 6 (100) | 22 (67) k | .027 h,i |
| Diabetes with complications | 13 (27) j | 1 (11) | 5 (83) | 7 (21) k | .003 h,i |
| Congestive heart failure | 16 (33) j | 4 (44) | 4 (67) | 8 (24) k | .094 |
| Chronic pulmonary disease | 13 (27) j | 1 (11) | 3 (50) | 9 (27) k | .252 |
| Renal disease | 12 (25) j | 3 (33) | 2 (33) | 7 (21) k | .668 |
| Current device(s) present or 14 days before incident specimen | |||||
| BiPAP/CPAP | 5 (9) l | 1 (11) | 0 (0) | 4 (9) m | .718 |
| Feeding tube | 55 (93) l | 9 (100) | 6 (100) | 39 (91) m | .473 |
| Mechanical ventilation | 31 (53) l | 5 (56) | 6 (100) | 20 (47) m | .048 h |
| PICC line | 28 (48) l | 4 (44) | 4 (67) | 20 (47) m | .632 |
| Tracheostomy | 42 (72) l | 7 (78) | 6 (100) | 29 (67) m | .229 |
| Urinary catheter | 18 (31) l | 5 (56) | 2 (33) | 11 (25) m | .191 |
| ≥3 devices | 43 (62) l | 8 (73) | 6 (86) | 29 (57) m | .248 |
| Special care services | |||||
| Hemodialysis | 22 (38) l | 4 (44) | 3 (50) | 15 (35) m | .704 |
| Decubitus ulcers | 12 (27) n | 3 (38) o | 2 (40) p | 7 (22) q | 0.519 |
| Antibiotic therapy, 14 d before incident specimen | |||||
| Meropenem | 16 (36) r | 4 (50) n | 3 (60) o | 9 (29) s | .277 |
| Vancomycin | 23 (52) r | 4 (50) n | 4 (80) o | 15 (48) s | .418 |
| Cefepime | 9 (20) r | 3 (38) n | 1 (20) o | 5 (16) s | .409 |
Note. VIM, Verona-integron-encoded metallo-β-lactamase; KPC, Klebsiella pneumoniae carbapenemase; LOS, length of stay; ICU, intensive care unit; BiPAP/CPAP, bilevel/continuous positive airway pressure; PICC, peripherally inserted central catheter. P values were calculated using the Pearson χ2 test for categorical variables and the Welch unequal variance t test for continuous variables.
Excludes 8 case patients who had CPO identified from admission screening.
Units unless otherwise specified.
For patients with both bla VIM and bla KPC, 5 of 6 had both carbapenemase genes identified on the same date (n=3) or within 7 days (n=2); date-specific analyses were performed using the date of specimen collection for the first incident case.
One of the 46 KPC cases was identified as KPC-CRPA, the remainder were KPC-CRE.
Pairwise comparison between bla KPC and bla VIM was <.05.
Clinical specimen sources include sputum (n=2), urine (n=4), and wounds (n=2).
Unable to conclusively assign time-point of CPO acquisition of no admission screening established before our first PPS and for those case-patients identified before when admission screening was implemented.
Pairwise comparison between bla VIM vs. bla VIM and bla KPC was <.05.
Pairwise comparison between bla KPC vs. bla VIM and bla KPC was <.05.
n=48.
No Charlson comorbidity index includes patients who may have had other comorbid conditions but did not have conditions included in the Charlson comorbitiy index.
n=58.
n=43.
n=45.
n=8.
n=5.
n=32.
n=44.
n=31.