1416. Surveillance for Carbapenem-Resistant Enterobacteriaceae (CRE), Minnesota, 2011
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Background: The emergence and spread carbapenem-resistant Enterobacteriacae (CRE) represents a public health threat. K. pneumoniae carbapenemase (KPC) is the most common plasmid-mediated carbapenemase reported in the U.S.; New Delhi metallo-beta-lactamase (NDM-1) has been rarely reported.  

Methods: The MN Dept. of Health (MDH) conducts statewide CRE surveillance. CRE isolates (non-susceptible to imipenem or meropenem and resistant to third generation cephalosporins, using 2011 CLSI breakpoints) were submitted for further characterization. All isolates underwent PCR for blaKPC, and select isolates for blaNDM-1 genes. Case medical records were reviewed.

Results: 57 CRE reports and 46 isolates were received from 53 patients; 52% (24/46) were KPC positive and 4% (2/46) were NDM-1 positive. E. cloacae (25, [13 KPC]) was the most common species followed by K. pneumoniae (11, [10 KPC, 1 NDM-1]), E. coli (4, [1 NDM-1]), C. freundii (4, [1 KPC]), and E. aerogenes (2). Of 48 cases with record review, median age was 59 years (range 1-91 yrs); 50% were male. 88% (42/48) of case isolates were cultured from urine (32) or a sterile site (10). Cases resided throughout MN. 63% (30/48) of cases were hospitalized at time of culture (8 in ICU), and 6 died during hospitalization. Median LOS was 14.5 days (range 2–238); 10 cases were admitted >3 days prior to specimen collection. Other cases included 12 outpatients, 5 LTACH and 1 LTCF. Urinary tract pathology (38%), diabetes (35%), and neurological conditions (31%) were the most common co-morbidities. 79% (38/48) of cases had at least one invasive device. Both NDM-1 positive isolates were from a single outpatient urine specimen. This case had recently traveled to and received medical care in India.

Conclusion: Statewide surveillance for CRE revealed a predominance of KPC; in addition, 2 NDM-1 isolates were found. Cases were detected throughout MN and across healthcare facility type. Early recognition of CRE and implementation of infection prevention and control measures in a healthcare facility is essential to reduce the risk of transmission. Detection of NDM-1 in an outpatient serves as a reminder that these organisms may return with the medical tourist.

Kristin M Shaw, MPH1, Jane Harper, BSN, MS, CIC1, Paula Snippes Vagnone, MT (ASCP)1, Kelly Gall, BS1, Kate Klammer, BS2 and Ruth Lynfield, MD1, (1)Minnesota Department of Health, St. Paul, MN, (2)Minnesota Department of Health, Saint Paul, MN

Disclosures:

K. M. Shaw, None

J. Harper, None

P. S. Vagnone, None

K. Gall, None

K. Klammer, None

R. Lynfield, None

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