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Although the problem of antibiotic resistance is always worrisome, the emergence of carbapenem-resistant Enterobacteriaceae during the last decade has been particularly frightening, given the possibility that these organisms will become resistant to all available antibiotics. Consequently, when carbapenem-resistant Klebsiella pneumoniae (CRKP) was identified in two hospitals in Los Angeles in 2009, the Los Angeles County Department of Public Health initiated a surveillance system to determine the incidence of this pathogen.
From June 2010 through May 2011, 675 confirmed cases of CRKP colonization or infection occurred in Los Angeles County. Cases were reported from acute care hospitals (ACHs; 57%), long-term acute care facilities (LTACs; 34%), and skilled nursing facilities (SNFs; 8%). Among institutions with at least one case, the pooled mean incidence per 1000 patient-days was 0.31 for 57 ACHs and 2.54 for 8 LTACs; rates could not be calculated for SNFs due to lack of census data. Sixty percent of cases were considered to be hospital acquired; and of the 232 cases considered community acquired, 63% involved admission from an SNF.
Marquez P et al. Population-based incidence of carbapenem-resistant Klebsiella pneumoniae along the continuum of care, Los Angeles County. Infect Control Hosp Epidemiol 2013 Feb; 34:144. 9 (http://dx.doi.org/10.1086/669087)
Comment
Because this study relied on passive surveillance for case identification, CRKP incidence in Los Angeles County may actually have been higher than described here. The findings reinforce the concern that LTACs and SNFs have become reservoirs for multidrug-resistant organisms. Efforts to control the spread of these pathogens must incorporate measures to improve infection control and antibiotic stewardship programs in these facilities.