Mapping Demographic and Microbiological Correlates in Post GI-Procedure Carbapenemase Producing Klebsiella pneumoniae (KPC) infections in Florida

Background: Initially reported from North Carolina KPC is known as a “Superbug’ which carries an innate capability to cause high mortality with limited options for treatment.  Post procedure KPC Klebsiella pneumoniae has not been widely reported.
Objective: Clinical audit of post procedure KPC Klebsiella pneumonia infections at two tertiary care referral teaching hospitals in Tampa, Florida.

Methods: Data was collected after detailed assessment of multiple variables from charts of seven patients with proved KPC Klebsiella pneumonia infections from Tampa General Hospital (TGH) and Moffitt Cancer Center (MCC) both tertiary care teaching hospitals in South Florida. The infections were noticed in referred patients who underwent GI procedures namely EGD, ERCP or laparoscopic cholecystectomy between June‘08 to Feb ’09 at the referring hospitals.  Detailed study of demographics and laboratory variables was done which included analysis of microbiology data from cultures of blood, respiratory, urine and wounds. Detailed study of antibiotic susceptibility and final outcomes was also done. Results: Majority of our patients were males aged between 59 to 83 years.  A total of 7 patients were diagnosed with KPC Klebsiella pneumonia infection and confirmed with Hodge test. 6 patients had either EGD or ERCP and the 7^th patient had a laparoscopic cholecystectomy.  6 of the patients had a diagnosed GI malignancy and the average length of stay in the hospital was between 10 to 86 days.  KPC bacteremia was diagnosed in 6 patients while 4 patients had KPC positive urine cultures. Only one patient had positive wound and respiratory culture while 3 patients had positive abdominal/biliary drain cultures. Other organisms isolated from blood included Candida albicans, coagulase negative staphylococcus, Proteus mirabilis and Staphylococcus lugdunesis.  Cephalosporins, piperacillin/tazobactam were used as empiric therapy prior to diagnosis of KPC. Our Isolates demonstrated variable resistance to aminoglycosides. One of the isolates was sensitive to imipenem but resistant to doripenem. The final outcomes of these referred patients were variable with two being discharged to hospice and one died in the hospital.
Conclusions: All our seven patients were transferred from outside referring hospitals where they underwent GI procedures. Post procedure infections call for protocols enhancing surveillance and practice of strict infection control in immunochallenged patients. Prolonged length of stay, rising costs, escalation in resistant organisms and worsening outcomes are some of the many results of such infections. Our assessment reports the arrival of post procedure KPC infection as a challenging event as we move ahead to secure an infection controlled hospital environment.