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Transmission of carbapenem-resistant pathogens in New York City hospitals: progress and frustration

David Landman1, Elizabeth Babu, Neha Shah

  • 1Division of Infectious Diseases, Department of Medicine, State University of New York-Downstate Medical Center, Brooklyn, New York, USA.

The Journal of Antimicrobial Chemotherapy
|March 2, 2012
PubMed
Abstract

Insights

Carbapenem-resistant Klebsiella pneumoniae rates decreased, but Acinetobacter baumannii and Pseudomonas aeruginosa resistance worsened. Shorter hospital stays may aid infection control for KPC- Klebsiella pneumoniae.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Hospital Epidemiology

Background:

  • Carbapenem-resistant Gram-negative bacteria, including Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa, pose significant challenges in healthcare settings due to limited treatment options.
  • Understanding the epidemiology and controlling the transmission of these multidrug-resistant organisms (MDROs) is critical for patient safety and effective healthcare management.

Purpose of the Study:

  • To assess the prevalence and trends of carbapenemase-producing K. pneumoniae, A. baumannii, and P. aeruginosa in New York City hospitals.
  • To compare current resistance patterns with previous data and identify factors associated with changes in prevalence.
  • To evaluate the impact of infection control measures on the spread of these resistant pathogens.

Main Methods:

  • Collection of bacterial isolates (K. pneumoniae, A. baumannii, P. aeruginosa) from 14 New York City hospitals in 2009.
  • Analysis of isolates for the presence of carbapenemase genes, including KPC and OXA types.
  • Comparison with a similar study from 2006 and collection of hospital demographic and infection control data.

Main Results:

  • A significant decrease in KPC-producing K. pneumoniae was observed (29% in 2009 vs. 38% in 2006, P < 0.001).
  • Carbapenem resistance increased in A. baumannii and P. aeruginosa, primarily due to OXA-type carbapenemases.
  • Hospitals with a declining prevalence of KPC-producing K. pneumoniae showed shorter average lengths of stay.

Conclusions:

  • Progress has been made in reducing the spread of KPC-producing K. pneumoniae, with shorter hospital stays potentially contributing to infection control.
  • The persistent challenge of carbapenem-resistant A. baumannii and P. aeruginosa necessitates further investigation.
  • Novel infection control strategies, such as enhanced environmental cleaning and respiratory isolation, should be explored for A. baumannii and P. aeruginosa.

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