1415. Carbapenem-Resistant Klebsiella pneumoniae in Los Angeles: A Descriptive Analysis of Cases
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Posters
  • CRKP_POSTER_FINAL[1].pdf (187.3 kB)
  • Background:

    The epidemiology of carbapenem-resistant (CR) Klebsiella pneumoniae (KP) on the US West Coast is poorly understood. 

    Methods:

    Retrospective observational study of unique inpatients at our 950 bed hospital with clinical culture for CRKP per CLSI criteria between 9/09 and 3/12. Prior history of CRKP was identified in collaboration with LA County Public Health (LAC) as follows: our cohort was cross-referenced with an existing surveillance database of prior CRKP cases reported to LAC from other health care facilities (HCF), and LAC surveyed HCF from which our cases were admitted for epidemiologic data. 

    Results:

    51 cases were identified; median age was 69 years, median LOS was 14 days, and 49% required ICU care. 63% were admitted from another acute/chronic HCF; 6 patients were previous residents of a single HCF.  4 were found to have CRKP isolated from other LA HCF prior to admission; 3 via LAC surveillance and 1 via survey.  VRE, MRSA, and ESBL were identified within the prior year in 60.8%, 25.5%, and 21.6%, respectively. Also within the prior year, 19.6% had other CR gram-negative bacteria identified, and KP without CR was seen in 27.4% (most within 1 month prior to CRKP identification). Recent exposure to carbapenems (39.2%) or anti-pseudomonal β-lactams (74.5%) was common.

    CRKP was isolated most frequently from urine (53%); respiratory (16%) and blood (6%) isolates were less frequent.  Resistance was common to all aminoglycosides (47.1%), fluoroquinolones (94%), and tigecycline (62.7% intermediate or resistant). The median colistin MIC was 1 µ/mL.

    CRKP represented clinical infection in 78.4%; hospital mortality in this infected cohort was 20% (8/40), while mortality in colonized patients was 9% (1/11, p=0.66). No patients with CRKP infection were on effective empiric antibiotics at time of culture.  Of 35 patients later receiving appropriate antibiotics, time from culture to initiation of therapy was 4.29 days in those that died (n=7) compared to 3.75 days in survivors (n=28, p=0.50).

    Conclusion:

    In Los Angeles, CRKP are becoming more frequent in patients with exposure to other HCF, broad-spectrum antibiotics, and a history of other drug resistant pathogens. Delays in effective therapy are common and may be associated with increased mortality.

    Arzhang Cyrus Javan, MD1, Jonathan Grein, MD2, Patricia Marquez, MPH3, Andrea Censullo, MD4, Margie Morgan, PhD5, Dawn Terashita, MD, MPH3 and Rehka Murthy, MD2, (1)Infectious Diseases, Cedars-Sinai/UCLA Multicampus Program in Infectious Diseases, Los Angeles, CA, (2)Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA, (3)Los Angeles County Department of Public Health, Los Angeles, CA, (4)Internal Medicine, Cedars Sinai, Los Angeles, CA, (5)Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA

    Disclosures:

    A. C. Javan, None

    J. Grein, None

    P. Marquez, None

    A. Censullo, None

    M. Morgan, None

    D. Terashita, None

    R. Murthy, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 17th with the exception of research findings presented at the IDWeek press conferences.