1601. Surveillance for Klebsiella pneumoniae Carbapenemase (KPC)-Producing Enterobacteriaceae
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as a public health threat. CRE infections are associated with higher morbidity and mortality than carbapenem-susceptible organisms. CRE spread in healthcare (HC) settings has occurred. In 2009, the MN Dept. of Health (MDH) detected a KPC-producing CRE and initiated surveillance for CRE.

Methods: Voluntary reporting of CRE is conducted statewide; active, lab-based surveillance occurs in the 2 most populous counties. During 2011-2012, CRE isolates were submitted to MDH and underwent PCR testing for blaKPC. If positive, case medical records were reviewed.

Results: 118 CRE isolates were submitted. 50 incident isolates (21, 2011; 29, 2012) from 46 patients were blaKPC positive; 13 patients had recurrent isolates of the same species within 1 year of initial culture. K. pneumoniae (24) and E. cloacae(23) were the most common organisms. Urine (26) was the most common culture source followed by sputum (7), wound (5), blood (4), other respiratory (4), peritoneal (2), bone (1), and other (1).

48 medical records were available for review. Median age was 58 yrs (range 6 mo-91 yrs); 54% were male and 44% (21/48) were active surveillance area residents. 98% had a co-morbidity (diabetes [24] and neurological condition [22]). All cases had an invasive device (74%: urinary catheter [28]; CVC [16]; or other invasive device [24]) within the 2 days prior to culture and/or a HC exposure (93%: hospitalization [38]; surgery [23]; dialysis [8]; or LTCF resident [22]) within the prior year.

65% (31/48) had a known hospitalization within 30 days of culture; 55% of these required ICU care and, median LOS was 16 (range 1-238) days. In-hospital mortality was 19%. 64% of surviving cases were discharged to LTCF or LTACH. Other cases were from LTACH (7), outpatient (7), or LTCF (3).

Conclusion: ­­KPC-producing CRE has emerged in MN; K. pneumoniae and E. cloacae are the most common organisms. All cases had HC–associated risk factors. Many had significant morbidity including intensive care, and a fatality rate of nearly 20% among hospitalized cases. Notably, 2/3 of hospitalized cases were discharged to another facility, highlighting the importance of communication and implementation of infection prevention measures. Ongoing surveillance will be important to determine trends and assess prevention measures.

Kristin M Shaw, MPH, CIC, Jane Harper, BSN, MS, CIC, Paula Snippes Vagnone, MT (ASCP) and Ruth Lynfield, MD, Minnesota Department of Health, St. Paul, MN


K. M. Shaw, None

J. Harper, None

P. S. Vagnone, None

R. Lynfield, None

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