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<p>With limited treatments for carbapenem-resistant <i>Klebsiella pneumoniae</i> (CR<i>Kp)</i>, curtailing transmission is critical. We applied a network analysis using epidemiological admission data and bacterial genetics to characterize CR<i>Kp</i> spread among patients in 16 acute care hospitals linked to 217 other healthcare facilities in the United States. Patients with diagnosed CR<i>Kp</i> infection were selected from the Consortium on Resistance Against Carbapenems in <i>Klebsiella</i> and other Enterobacteriaceae (CRACKLE-1), a prospective, observational study conducted from 12/2011 to 6/2016. A network analysis was performed using epidemiological admission data and bacterial genetics to characterize putative CR<i>Kp</i> transmission among patients across various healthcare facilities and the community. Overall, 347/526 patients (66%) had a putative transmission link to at least one other patient within the network. Most transmission chains were small (i.e., between 2 patients); however, the largest included 172 patients diagnosed over 1575&#xa0;days. One-third of patients shared a genetically similar CR<i>Kp</i> isolate with another patient but had no observed epidemiological linkages at any healthcare location. Patients with CR<i>Kp</i> are part of extensive regional networks involving a large number of non-hospital healthcare settings such as skilled nursing facilities. Thus, controlling spread necessitates integrated surveillance and control initiatives at regional and national levels in addition to institution-specific approaches.</p>

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A network analysis of carbapenem-resistant Klebsiella pneumoniae among healthcare facilities

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月29日

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  • Courtney L. Luterbach,
  • Dana K. Pasquale,
  • Heather I. Henderson,
  • Eric Cober,
  • Sandra S. Richter,
  • Robert A. Salata,
  • Robert C. Kalayjian,
  • Richard R. Watkins,
  • Andrea M. Hujer,
  • Kristine M. Hujer,
  • T. Nicholas Domitrovic,
  • Yohei Doi,
  • Keith S. Kaye,
  • Scott Evans,
  • Vance G. Fowler Jr.,
  • Robert A. Bonomo,
  • Barry Kreiswirth,
  • Liang Chen,
  • Cesar A. Arias,
  • James Moody,
  • David van Duin,
  • Chip Chambers,
  • Toshi Hamasaki,
  • Robin Patel,
  • Heather Cross,
  • Anthony Harris,
  • Melinda Pettigrew,
  • David van Duin,
  • Helen Boucher,
  • Clayton Huntley,
  • Lanling Zou,
  • Erica Raterman,
  • Tamika Samuel,
  • Kyung Moon,
  • Kim Hanson,
  • Yohei Doi,
  • Thomas Holland,
  • Tom Lodise,
  • Sam Shelburne,
  • Ritu Banerjee,
  • Sara Cosgrove,
  • David Paterson,
  • Ebbing Lautenbach,
  • Maureen Mehigan,
  • Sarah Doernberg,
  • Sam Perdue,
  • John Beigel,
  • David Roach

摘要

With limited treatments for carbapenem-resistant Klebsiella pneumoniae (CRKp), curtailing transmission is critical. We applied a network analysis using epidemiological admission data and bacterial genetics to characterize CRKp spread among patients in 16 acute care hospitals linked to 217 other healthcare facilities in the United States. Patients with diagnosed CRKp infection were selected from the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE-1), a prospective, observational study conducted from 12/2011 to 6/2016. A network analysis was performed using epidemiological admission data and bacterial genetics to characterize putative CRKp transmission among patients across various healthcare facilities and the community. Overall, 347/526 patients (66%) had a putative transmission link to at least one other patient within the network. Most transmission chains were small (i.e., between 2 patients); however, the largest included 172 patients diagnosed over 1575 days. One-third of patients shared a genetically similar CRKp isolate with another patient but had no observed epidemiological linkages at any healthcare location. Patients with CRKp are part of extensive regional networks involving a large number of non-hospital healthcare settings such as skilled nursing facilities. Thus, controlling spread necessitates integrated surveillance and control initiatives at regional and national levels in addition to institution-specific approaches.