Rise and fall of KPC-producing Klebsiella pneumoniae in New York City

The study objective was to examine the epidemiological trends of KPC-producing Klebsiella pneumoniae in New York City medical centres. Single patient isolates of K. pneumoniae were collected from nine medical centres in New York City during a 3 month period from 2013 to 2014. Isolates were tested for the presence of bla(KPC). Results were compared with similar surveillance studies conducted in 2006 and 2009. Infection control data, including utilization of medical devices, were analysed at a subset of hospitals. There was a progressive decline in the percentage of K. pneumoniae harbouring bla(KPC) from 2006 to 2013-14. For the nine hospitals that participated in all three surveillance studies, the percentages of isolates with bla(KPC) fell from 36% in 2006 to 25% in 2009 to 13% in 2013-14. Seven of the nine hospitals had marked declines in isolates with bla(KPC), while two hospitals continued to struggle with this pathogen. These two hospitals were smaller and had longer lengths of patient stay. Device utilization rates were obtained from two hospitals that successfully controlled the spread of KPC-producing K. pneumoniae; both had similar to 20%-25% reduction in the usage of urinary catheters. Changes in antibiotic usage at one hospital could not explain the decline in these pathogens. Over the past decade there has been a steady decline in KPC-producing K. pneumoniae in most New York City hospitals. The reason for the decline is probably multifactorial, involving a reduction in device (catheter) utilization and possibly an improvement in infection control practices.