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BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) are an emerging public health threat requiring coordinated control efforts. A high prevalence of CRE colonization has been reported among long-term care facility (LTCF) residents in other parts of the country. However, the prevalence of CRE among LTCF residents in North Carolina is unknown. On June 13, 2013, the NC Division of Public Health was notified of 8 residents of a single LTCF who were colonized or infected with extended-spectrum beta-lactamase (ESBL) producing organisms or with CRE.
METHODS: We reviewed residents’ medical records, observed infection control practices at the facility, and collected rectal swabs from all current facility residents to screen for CRE. Cultures and antimicrobial susceptibility testing were performed by local hospitals and resistance mechanism testing was performed at CDC.
RESULTS: Through medical record review, we identified 5 residents in whom CRE infection or colonization had been identified during August, 2012–June, 2013; ESBL-producing organisms for which carbapenem susceptibilities were unknown had been isolated from an additional 11 residents during this timeframe. Screening of 74 persons residing in the LTCF during June, 2013 identified 9 (12%) who were colonized with CRE. Among 25 total ESBL- or CRE-positive residents, Klebsiella pneumoniae were identified from 16 (64%), Escherichia coli from 6 (24%), and both from 3 (12%). We identified the blaKPC gene by polymerase chain reaction testing in 3/3 Klebsiella pneumoniae isolates submitted to CDC, confirming Klebsiella pneumoniae carbapenemase as the mechanism of resistance. Opportunities for transmission were observed, including inadequate hand hygiene during and following resident care and failure to implement contact isolation for ESBL- or CRE-positive residents.
CONCLUSIONS: This is the first outbreak of ESBL and CRE identified and described in a North Carolina LTCF. Active screening revealed a high prevalence of unrecognized CRE colonization among current residents. These findings underscore the need for improved efforts to detect CRE among LTCF residents so that appropriate measures can be taken to prevent transmission.