1424. Characteristics of Episodes of Positive Cultures for Carbapenem Non-Susceptible Gram-Negative Bacilli from Three Communities
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Background: Carbapenem resistance is an increasing problem among Acinetobacter and Enterobacteriaceae. To describe the population at risk for these organisms, the Centers for Disease Control and Prevention’s Emerging Infections Program (EIP) piloted a population-based surveillance program.  

Methods: Surveillance for Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter aerogenes, and Enterobacter cloacae was conducted among residents of EIP catchment areas in Georgia, Minnesota, and Oregon (surveillance population 7,206,683) from 8/1/2011 to 12/31/2011 by querying automated laboratory instruments for antimicrobial susceptibility results. Sterile site and urine isolates non-susceptible to carbapenems (meropenem, imipenem or doripenem) and, for Enterobacteriaceae, also resistant to 3rd generation cephalosporins were identified. Healthcare exposures (hospitalization, long-term care admission, surgery, or dialysis in the prior year or presence of an indwelling device at the time of positive culture) were obtained from chart reviews. Isolates from cultures collected >3 calendar days after admission were classified as hospital-onset.

Results: 74 carbapenem-non-susceptible Enterobacteriaceae (CRE) and 45 carbapenem-non-susceptible A. baumannii (CRAB) episodes were identified from 66 and 41 patients, respectively. The majority of isolates were from Georgia (61 CRE, 42 CRAB), followed by Minnesota (10 CRE, 3 CRAB) and Oregon (3 CRE, 0 CRAB). Most CRE were K. pneumonia (46/74). Urine was the most common source (CRE 67/74, CRAB 30/45); sterile sites were infrequently involved (CRE 10/74, CRAB 18/45). The majority had onset outside the hospital (48/73 CRE and 26/45 CRAB) but most of these were associated with at least one healthcare exposure (41/48 CRE, 25/26 CRAB), most commonly a prior hospital admission (CRE) or presence of a urinary catheter (CRAB).

Conclusion: Nearly 120 CRE and CRAB were identified in 5 months, mostly from urine specimens. Although most were isolated from patients with healthcare exposures, they most often occurred outside of hospitals suggesting epidemiologic study of these pathogens should cross a variety of care settings.

Alexander Kallen, MD, MPH, FSHEA1, Sandra Bulens, MPH2, Jesse Jacob, MD3,4, Paula Snippes Vagnone, MT (ASCP)5, Jessica Reno, MPH4, Margaret Cunningham, MPH6, Calista Schenck, MPH4, Kristin M Shaw, MPH5, Jane Harper, BSN, MS, CIC5, Janine Scott, MPH4, Susan M. Ray, MD3,4, Shelley Magill, MD, PhD1, Zintars G. Beldavs, MS6 and Ruth Lynfield, MD5, (1)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (2)Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, GA, (3)Emory University School of Medicine, Atlanta, GA, (4)Georgia Emerging Infections Program, Decatur, GA, (5)Minnesota Department of Health, St. Paul, MN, (6)Oregon Health Authority, Portland, OR

Disclosures:

A. Kallen, None

S. Bulens, None

J. Jacob, None

P. S. Vagnone, None

J. Reno, None

M. Cunningham, None

C. Schenck, None

K. M. Shaw, None

J. Harper, None

J. Scott, None

S. M. Ray, None

S. Magill, None

Z. G. Beldavs, None

R. Lynfield, None

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