Fecal Microbiota Dynamics During Klebsiella pneumoniae carbapenemase (KPC) Acquisition in Long-Term Acute Care Hospital (LTACH) Patients

Anna Seekatz, Christine M. Bassis, Karen Lolans, Koh Okamoto, Nicholas M. Moore, Yoona Rhee, Laura Bardowski, Pamela Bell, Efrain Salazar, Thelma Dangana, Galina Sidimirova, Robert A. Weinstein (+4 others)
2016 Open Forum Infectious Diseases  
Background. KPC-producing bacteria pose a serious healthcare problem. Colonization with KPC typically precedes infection; identification of novel risk factors for colonization acquisition may reveal new targets for infection prevention. This study prospectively compared the fecal microbiota in LTACH patients who acquired KPC to identify potential microbial signatures associated with acquisition. Methods. Weekly rectal swab samples were collected from patients admitted to 1 LTACH from May to
more » ... ACH from May to October 2015; medical records were reviewed. Sampling was conducted throughout the patients' stays at weekly intervals. Samples underwent qPCR for bla KPC to determine KPC status. To compare the microbiota community in patients over time, total DNA from each sample was isolated, and the 16S rRNA V4 region was polymerase chain reaction-amplified and sequenced. Sequences were processed using mothur. Alpha and beta diversity measures were calculated to determine microbiota differences between patients and within a patient over time. Results. Thirty-two patients acquired KPC; 11 (31%) were women, with a median age of 63 years. Median length of stay before acquisition was 21 days; antibiotics were received for a median 74% of days. For KPC-converters, an average of 4.8 samples were collected/patient; 46% were positive for KPC. Samples clustered into 5 phylotypes using the partitioning around medoids clustering (average silhouette score = 0.20). We saw no significant difference in alpha diversity (inverse Simpson index) between KPC positive or negative samples. However, a decrease in microbiota diversity occurred immediately prior to and at initial KPC acquisition (Kruskal-Wallis test,
doi:10.1093/ofid/ofw172.1774 fatcat:ho4bv3kxtvca5igftl4pkodxmu