1400. Molecular and Clinical Correlation in Carbapenem-Resistant Klebsiella pneumonia (CR-Kp): Establishment of a Surveillance Network in Northeast Ohio (NeOSuN)
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H

CR-Kp is a globally spreading virulent pathogen. We aim to define the molecular and clinical characteristics of CR-Kp in NeO, through a novel surveillance network (NeOSuN).


NeO SuN is composed of 4 health systems, with 19 hospitals serving 2 million people.  Clinical data was entered prospectively into a central database for each hospitalized patient with CR-Kp. A central laboratory performed carbapenemase identification (PCR), and genotyping (repetitive sequence-based PCR [repPCR] and multilocus sequence typing [MLST]).


Between 12/25/2011 and 4/25/2012, 53 unique patients (median age 73 years, 68% female, 62% Caucasian, median Charlson score 4, range 1-11) were included, with 62 admissions and 76 CR-Kp isolates. Admissions from nursing homes (NH) (34/62, 55%) or other hospitals including long term acute care (LTAC) facilities (12/62 19%) predominated. Hospital mortality and ICU admission rates were 12/62 (19%) and 31/62 (50%), respectively.  Most admissions resulted in discharge to NH (30/50, 60%), or hospital (including LTAC) transfer (7/50, 14%). Median length of stay was 11 days (range 1-71).  The majority of isolates grew from urine (49/76, 64%), with 33/49 (67%) associated with a Foley catheter. Colistin and tigecycline resistance were found in 4/42 (10%), and 6/56 (11%) of tested isolates, respectively; no isolate was resistant to both.  In 62 admissions, treatment included tigecycline (20/62), amikacin (14/62), gentamicin (10/62), colistin (8/62), and fosfomycin (6/62).  In tested isolates, blaKPC-2 was detected in 17/22 (77%), and blaKPC-3 in 5/22 (23%).  The majority of isolates were either RepPCR type A (21/32, 66%), or type B (8/32, 25%); both MLST sequence type 258.  Type A strains were more likely to be blaKPC-2-positive (16/17 vs. 1/5, p<0.01) and gentamicin susceptible (9/17 vs. 0/7, p=0.02) than non-A types. In-hospital mortality associated with type A was 33% (6/18), vs 0% (0/9) for non-A (p=0.02).


CR-Kp was most often recovered from elderly NH residents during acute-care hospitalization in NeO.  RepPCR type A, blaKPC-2-positive CR-Kp may be associated with increased mortality.  This prospective surveillance network may identify risks associated with CR-Kp involving a vulnerable patient population.

David van Duin, MD, PhD1, Federico Perez, MD2, Jennifer Hanrahan, DO3, Eric Cober, MD4, Marianne Cline5, Raymond Webber, M.S.6, Julie Ziegler3, Dana Crowe5, Gerri S. Hall, PhD7, Michael Jacobs, MD8, Robert Kalayjian, MD9, Robert Salata, MD10 and Robert A. Bonomo, MD2, (1)Infectious Diseases, Medicine Institute and Transplant Center, Cleveland Clinic Foundation, Cleveland, OH, (2)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (3)MetroHealth, Cleveland, OH, (4)Infectious Disease, Cleveland Clinic, Cleveland, OH, (5)Cleveland Clinic, Cleveland, OH, (6)Case Western Reserve University, Cleveland, OH, (7)Pathology and Lab Medicine, Cleveland Clinic, Cleveland, OH, (8)Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH, (9)The MetroHealth Medical Center, Cleveland, OH, (10)University Hospitals Case Medical Center, Cleveland, OH


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

F. Perez, None

J. Hanrahan, None

E. Cober, None

M. Cline, None

R. Webber, None

J. Ziegler, None

D. Crowe, None

G. S. Hall, None

M. Jacobs, None

R. Kalayjian, None

R. Salata, None

R. A. Bonomo, Pfizer: Grant Investigator, Grant recipient
AstraZeneca: Grant Investigator, Grant recipient
Rib-X: Grant Investigator, Grant recipient

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