A network analysis of carbapenem-resistant Klebsiella pneumoniae among healthcare facilities

Courtney L. Luterbach, Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina, Chapel Hill, NC, USA.
Dana K. Pasquale, Department of Sociology, Duke University, Durham, NC, USA.
Heather I. Henderson, Division of Infectious Diseases, University of North Carolina, CB# 7030, Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC, 27599-7030, USA.
Eric Cober, Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA.
Sandra S. Richter, Department of Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, FL, USA.
Robert A. Salata, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Robert C. Kalayjian, Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
Richard R. Watkins, Division of Infectious Diseases, Northeast Ohio Medical University, Rootstown, OH, USA.
Andrea M. Hujer, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Kristine M. Hujer, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
T Nicholas Domitrovic, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Yohei Doi, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Keith S. Kaye, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Scott Evans, The Biostatistics Center, The George Washington University, Rockville, MD, USA.
Vance G. Fowler, Division of Infectious Diseases, Duke University, Durham, NC, USA.
Robert A. Bonomo, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Barry Kreiswirth, Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA.
Liang Chen, Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA.
Cesar A. Arias, Division of Infectious Diseases and Center for Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston, TX, USA.
James Moody, Department of Sociology, Duke University, Durham, NC, USA.
David van Duin, Division of Infectious Diseases, University of North Carolina, CB# 7030, Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC, 27599-7030, USA. vanduin@med.unc.edu.

Document Type

Journal Article

Publication Date

7-29-2025

Journal

Scientific reports

Volume

15

Issue

1

DOI

10.1038/s41598-025-04918-0

Keywords

Antimicrobial resistance; Bacterial typing; Enterobacterales; Infection control; Network analysis; Nosocomial infections

Abstract

With limited treatments for carbapenem-resistant Klebsiella pneumoniae (CRKp), curtailing transmission is critical. We applied a network analysis using epidemiological admission data and bacterial genetics to characterize CRKp spread among patients in 16 acute care hospitals linked to 217 other healthcare facilities in the United States. Patients with diagnosed CRKp infection were selected from the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE-1), a prospective, observational study conducted from 12/2011 to 6/2016. A network analysis was performed using epidemiological admission data and bacterial genetics to characterize putative CRKp transmission among patients across various healthcare facilities and the community. Overall, 347/526 patients (66%) had a putative transmission link to at least one other patient within the network. Most transmission chains were small (i.e., between 2 patients); however, the largest included 172 patients diagnosed over 1575 days. One-third of patients shared a genetically similar CRKp isolate with another patient but had no observed epidemiological linkages at any healthcare location. Patients with CRKp are part of extensive regional networks involving a large number of non-hospital healthcare settings such as skilled nursing facilities. Thus, controlling spread necessitates integrated surveillance and control initiatives at regional and national levels in addition to institution-specific approaches.

Department

Biostatistics and Bioinformatics

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