Notes from the Field: Carbapenemase-Producing Klebsiella pneumoniae in a Ventilator-Capable Skilled Nursing Facility — Maricopa County Arizona July–November 2018

摘要

On August 2, 2018, Maricopa County (Arizona) Department of Public Health (MCDPH) identified two isolates of carbapenemase-producing (KPC-KP), a type of carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE), from urine specimens collected on July 17 and July 23 from two residents of a ventilator-capable unit in a skilled nursing facility. CP-CRE are multidrug-resistant organisms typically isolated from persons with a health care exposure ( , ). Invasive CP-CRE infections are associated with a 50% case-fatality rate ( ); however, only 31%–63% of asymptomatic carriers are identified with clinical cultures ( , ) and might serve as sources of CP-CRE transmission. Both residents at this skilled nursing facility had indwelling urinary catheters and urinary tract infections, resided in neighboring rooms, and were dependent on nursing care for their activities of daily living; one resident was mechanically ventilated. The Antibiotic Resistance Laboratory Network Mountain Region laboratory in Austin, Texas, performed pulsed-field gel electrophoresis (PFGE) on the two clinical isolates, which were found to have indistinguishable PFGE patterns, suggesting health care–associated transmission. MCDPH and the Arizona Department of Health Services (ADHS) investigated the cluster to prevent additional cases.