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Infectious Disease

Klebsiella pneumoniae Carbapenemase (KPC)

Klebsiella pneumoniae Carbapenemase (KPC)
DESCRIPTION:
Klebsiella is a type of gram-negative bacteria that can cause infections in healthcare settings, including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis. Klebsiella bacteria are normally found in the human intestines (where they do not cause disease) and in stool. Healthy people usually do not get Klebsiella infections.

DRUG-RESISTANT K. PNEUMONIAE:
Infection with carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemase-producing Enterobacteriaceae is emerging as an important challenge in health-care settings. Currently, carbapenem-resistant Klebsiella pneumoniae (CRKP), also known as *Klebsiellan pneumoniae Carbapenemase (KPC) in healthcare settings, is the species of CRE most commonly encountered in the United States. KPC is resistant to almost all available antimicrobial agents, and infections with KPC have been associated with high rates of morbidity and mortality, particularly among persons with prolonged hospitalization and those who are critically ill and exposed to invasive devices. This is considered a threat to patient safety because carbapenem antibiotics often are the last line of defense against gram-negative infections that are resistant to other antibiotics.
 
MODES OF TRANSMISSION:
In healthcare settings, Klebsiella can be spread through the following routes:
  • Person-to-person via the hands of healthcare personnel or other people
  • Indirectly through contamination in the environment
  • Devices
    • ventilators
    • intravenous catheters
    • urinary catheters
 
CONTACT PRECAUTIONS:
  • All patients colonized or infected with KPC or any carbapenemase-producing Enterobacteriaceae should be placed on contact precautions
  • Contact Precautions and other infection control measures should be strictly enforced.
  • PPE (don before entering room):
    • Gown
    • Gloves
  • Hand hygiene before donning and after removing PPE
  • Remove all PPE before leaving room, taking care not to contact environmental surfaces with clothing following removal of gown
 
ROOM CONSIDERATIONS:
  • Infected or colonized patients should be placed in private rooms or cohorted.
 
PATIENT TRANSPORT
  • Patient activities may need to be limited. (This is determined on a case-by-case basis)
  • If patient leaves room, maintain precautions to limit potential transmission to other patients or contamination of environmental surfaces or equipment.
 
PATIENT CARE EQUIPMENT
  • Dedicated patient-care equipment should be considered for the patient.
  • If use of common equipment or items is unavoidable, the items should be adequately cleaned and disinfected before use for another patient.
 
PATIENT AND FAMILY EDUCATION
  • Patients and their family members in close contact should be taught about the use of Contact Precautions and appropriate hand hygiene.
 
DISCONTINUE PRECAUTIONS:
  • CDC states that we should make a case by case decision regarding when to discontinue precautions.
  • It would be prudent to have one or more negative cultures before discontinuing Contact Precautions. Follow your facility's policy.
 
COLONIZATION:
  • Patients with unrecognized KPC colonization have served as reservoirs for transmission during health-care--associated outbreaks.
 
SURVEILLANCE:
  • Routine active microbiologic surveillance for KPCs is not recommended.
  • Acute care facilities should review microbiology records for the preceding 6-12 months to identify previously unrecognized cases.
  • Active surveillance should only be done if:
    • Previously unrecognized cases are identified in reviewing microbiology reports
    • New healthcare-associated cases identified
  • Active surveillance should be done in units with patients at high risk:
    • intensive care units
    • units where previous cases have been identified
    • units where many patients are exposed to broad-spectrum antimicrobials
  • Laboratory Surveillance:
  • The facility should establish a protocol in conjunction with CLSI guidelines to immediately alert epidemiology and infection control staff members if a CRE is identified.
 
REFERENCES:
*For the purposes of this fact sheet, the acronym KPC will be used, as it is the term most commonly used in healthcare facilities.
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