Related Experiment Videos
Multiply-resistant Klebsiella pneumoniae: failure of spread in community-based elderly care facilities
J Bird1, R Browning, R P Hobson
1Grampian Healthcare NHS Trust, Woodend Hospital, Aberdeen, Foresterhill.
Abstract:
Thirty-eight patients colonized with multiply-resistant, plasmid-mediated, expanded-spectrum beta-lactamase (SHV-2) producing Klebsiella pneumoniae (MRK), were discharged from hospital to 22 nursing or residential homes during a hospital-based outbreak, in the Grampian region of north-east Scotland. MRK colonized the urinary tract in 74%, stool in 58%, respiratory tract in 29% and wounds in 11%. Mean length of colonization was 160 days (range 7-548). Mean length of stay in the homes after aquisition of MRK was 298 days. Compared with a control group of MRK-negative residents, MRK-positive residents had histories of more hospital admissions, underlying disease and complete immobility. Evaluation of these homes showed high standards of care and good facilities. Despite prolonged carriage of MRK by the index cases there was no evidence of spread to the other 886 residents who were screened, and there was evidence of only minor environmental contamination. Given the available evidence, patients colonized with MRK can be accommodated in good-quality nursing and residential homes, on discharge from hospital, with little fear of spread to other residents.
Insights
Patients colonized with multiply-resistant Klebsiella pneumoniae (MRK) can be discharged to nursing homes without significant risk of spread. This study found no transmission to other residents despite prolonged MRK carriage.
Area of Science:
- Infectious Diseases
- Public Health
- Microbiology
Background:
- Multiply-resistant, plasmid-mediated, expanded-spectrum beta-lactamase (SHV-2) producing Klebsiella pneumoniae (MRK) poses a significant healthcare challenge.
- Hospital discharge of colonized patients to community settings like nursing homes requires careful consideration of transmission risks.
Purpose of the Study:
- To assess the risk of MRK transmission from colonized patients discharged to nursing and residential homes.
- To evaluate the colonization patterns and duration in patients transferred to long-term care facilities.
Main Methods:
- Prospective study involving 38 patients colonized with MRK discharged to 22 nursing/residential homes.
- Screening of 886 other residents and environmental sampling.
- Comparison of MRK-positive residents with a control group of MRK-negative residents.
Main Results:
- MRK colonized the urinary tract (74%), stool (58%), respiratory tract (29%), and wounds (11%) with a mean carriage duration of 160 days.
- No evidence of MRK spread to 886 screened residents; only minor environmental contamination was detected.
- MRK-positive residents had more hospital admissions, underlying diseases, and immobility compared to controls.
Conclusions:
- Good-quality nursing and residential homes can safely accommodate patients colonized with MRK post-hospital discharge.
- Prolonged carriage of MRK by index cases did not lead to significant transmission in the studied community settings.