208. A Multicenter Study of the Epidemiology of Colistin and Carbapenem Resistant Klebsiella pneumoniae; a preponderance of ST-258
Session: Poster Abstract Session: Antimicrobial Resistance: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1

A Multicenter Study of the Epidemiology of Colistin and Carbapenem Resistant Klebsiella pneumoniae; a preponderance of ST-258 

Background: Colistin is often the "last resort" antibiotic available to treat invasive carbapenem-resistant Klebsiella pneumoniae (CRKP) infections. In Detroit and Cleveland, colistin-resistant CRKP (Col-R CRKP) are emerging. Our objectives were to analyze epidemiology, clinical and molecular characteristics of these strains.

Methods: Medical records of patients with colistin-resistant (MIC ³4 µg/mL) CRKP strains isolated from Detroit and Cleveland (03/2008-04/2010) were reviewed. Antimicrobial susceptibility testing (AST), characterization by PCR amplification of blaKPC, and multilocus sequence typing (MLST).

Results: AST identified 23 isolates of unique patients: 14 from Detroit and 9 from Cleveland. Most patients were elderly, (>65 years), with extensive healthcare exposures, and received antibiotics (Table). 58% died in 3 months following their Col-R CRKP isolation. Of study isolates, 22 were available for genetic analysis: blaKPC was positive in all and 19 (86%) with the same MLST (ST-258).  

Conclusion: Emergence of Col-R CRKP ST258 is extremely concerning as crude mortality rates equals 58%. Molecular epidemiology surveillance, stewardship policies and infection control programs are of paramount importance in controlling spread of this organism

Characteristics of patients with Colistin-Resistant CRKP, Detroit-Cleveland, 2010-2011

Number (n=23)

Percent*

Demographics and general information

Age, years, mean ± SD

68 ± 14.5

Male sex

13

56.5%

African-American

15

65.2 %

Prior Dependent functional status

16

69.6%

Healthcare-associated exposures

Permanent non-home residency

17

74%

Recent hospitalization¤

19

90.5%

Recent exposure to any class of antimicrobials ¤

21

100%

Permanent devices

21

100%

Presence of a rapidly fatal condition

3

20%

Sepsis level

Sepsis syndrome

13

57%

Severe sepsis/septic shock/multi-organ failure

6

26%

Clinical syndrome

Colonization only

4

20%

Urinary tract infection

6

30%

Bacteremia

3

25%

Outcomes

90-days mortality

11

57.9%

Length of hospital stay from culture to discharge, median (IQR)

14.5 (8.3-31.5)

á      Percents are presented as "valid percents", excluding missings

¤ 3 months


Subject Category: A. Antimicrobial agents and Resistance

Odaliz Abreu-Lanfranco, MD1, Dror Marchaim, MD2, David van Duin, MD, PhD3, Federico Perez, MD4, Steve Marshall, MD5, Kayoko Hayakawa, MD, PhD6, Paul Lephart, PhD7, Geraldine Hall, PhD8, Michael Jacobs, MD9, Robert Bonomo, MD4 and Keith Kaye, MD, MPH, FIDSA2, (1)Division of ID, 5 Hudson, Wayne State University, Detroit Medical Center, Detroit, MI, (2)Detroit Medical Center (DMC) / Wayne State University, Detroit, MI, (3)Infectious Disease, Cleveland Clinic Foundation, Cleveland, OH, (4)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (5)Cleveland Clinic Foundation, Cleveland, OH, (6)Detroit Medical Center / Wayne State University, Detroit, MI, (7)DMC University Laboratories, Detroit, MI, (8)Cleveland Clinic, Cleveland, OH, (9)CWRU/University Hospitals Case Medical Center, cleveland, OH

Disclosures:

O. Abreu-Lanfranco, None

D. Marchaim, None

D. van Duin, Pfizer: Scientific Advisor, Consulting fee
Astellas: Speaker's Bureau, Speaker honorarium

F. Perez, None

S. Marshall, None

K. Hayakawa, None

P. Lephart, None

G. Hall, None

M. Jacobs, None

R. Bonomo, Check-points Inc: Grant Investigator, Grant recipient
Pfizer: Consultant, Consulting fee

K. Kaye, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.