1412. Using Antimicrobial Susceptibility Testing Data to Identify Possible Carbapenem-Resistant Klebsiella pneumoniae And Escherichia coli in Hawaii, 2005–2010
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
  • CRE poster - 1412 .pdf (458.2 kB)
  • Background:

    Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly concerning etiologies of some healthcare-associated (HAI) infections. Production of Klebsiella pneumoniae carbapenemase (KPC), the most common method of resistance, confers resistance to carbapenems as well as penicillins, cephalosporins, and aztreonam. As CRE infections are not reportable in Hawaii, we sought to identify any possible CRE infections, specifically those caused by K. pneumoniae and E. coli, occurring in our state from 2005–2010.


    We defined CRE as any isolate resistant to at least one carbapenem and all 3rd generation cephalosporins. All K. pneumoniae and E. coli antimicrobial susceptibility testing (AST) data were retrieved from the State of Hawaii Antimicrobial Resistance Project, which receives retrospective data from the state’s 4 major clinical laboratories biannually and comprises over 95% of AST data statewide. The 2012 carbapenem and cephalosporin minimum inhibition concentration resistance breakpoints determined by the Clinical and Laboratory Standards Institute were then applied to identify CRE isolates. The resulting data were analyzed for any epidemiological distinguishing characteristics and trends.


    A total of 818,541 AST results for K. pneumoniae and E. coli isolates tested against carbapenems and cephalosporins were reported to SHARP from January 2005–December 2010. We identified 48 isolates meeting the CRE definition. Urine was the primary clinical source for the majority of isolates 21 (44%), followed by wounds 9 (18%). The outpatient setting accounted for 20 (42%); whereas, the inpatient setting, 28 (58%) with specifically 8 (29%) of those originating from the ICU.  The annual median number of isolates for the study period was 8, range 5–14.


    This study illustrates the likely presence of CRE infections in Hawaii. Further investigation to obtain clinical records is needed to confirm these CRE and determine the clinical circumstances, evolution, and potential associated trends. Clearly, additional steps to ensure timely detection and prevent their transmission (e.g. through antimicrobial stewardship and healthcare provider education) are imperative.

    Zeshan Chisty, MPH1, Myra R. Ching-Lee, MPH2, Hua He, PhD2 and Sarah Y. Park, MD2, (1)Disease Outbreak Control Division , Hawaii Department of Health, Honolulu, HI, (2)Disease Outbreak Control Division, Hawaii Department of Health, Honolulu, HI


    Z. Chisty, None

    M. R. Ching-Lee, None

    H. He, None

    S. Y. Park, None

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