1578. Rectal colonization by drug resistant Enterobacteriaceae among international patients hospitalized at Mayo Clinic, Rochester, Minnesota
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: International travel and medical tourism have been associated with spread of resistant Enterobacteriaceae, including third generation cephalosporin-  and carbapenem-resistant Enterobacteriaceae (CRE). The epidemiology of colonization with such organisms among international patients hospitalized in the United States has not been defined.

Methods: Consecutive international patients hospitalized at Mayo Clinic, Rochester, MN from February 2013 onwards were enrolled.  All participants provided informed consent, a stool specimen or perirectal swab, and completed a survey.  CRE carriage was assessed by real-time PCR for Klebsiella pneumoniae carbapenemase and New Delhi-metallo-β-lactamase directly, and after overnight enrichment in tryptic soy broth. Specimens were also cultured on HardyCHROMTMESBL Agar, and in broth. After overnight incubation, broth was plated on eosin-methylene blue agar and screened for CREs using the CDC-recommended method. MALDI-TOF mass spectrometry and antimicrobial susceptibility testing were performed on isolates. Fisher’s exact or Chi Square tests were used for comparison of proportions.

Results: 69 patients from 27 different countries were screened during the first 3 months of the study. Most patients were from the Middle East (58%),followed by North America (12%), Asia (12%), Europe (9%), South America (7%), and other regions (3%). No CRE were detected, but 15 (22%) patients were colonized with third generation cephalosporin non-susceptible Enterobacteriaeceae. Carriage of cephalosporin non-susceptible Enterobacteriaceae was associated with hospitalization in the prior six months (RR 1.7, 95% CI 1.1-2.6, p = 0.04) and placement of a central venous catheter (CVC) within the past year (RR 3.1, 95% CI 1.2-7.8, p = 0.03). 

Conclusion: No CRE colonization was identified during interim analysis of this study of international patients hospitalized in the United States. Carriage of cephalosporin non-susceptible Enterobacteriaceae was found in 22% of patients, mostly from the Middle East; a history of hospitalization or having a CVC were risk factors for carriage.

Theresa Madigan, MD1, Shawn Vasoo, MD2, Scott A. Cunningham, MT(ASCP), SM2, Pritish K. Tosh, MD3, Robin Patel, MD, FIDSA, FRCP(C), D(ABMM), FACP, F(AAM)3,4, Priya Sampathkumar, MD3 and Ritu Banerjee, MD, PhD1, (1)Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, (2)Division of Clinical Microbiology, Dept. of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, (3)Infectious Diseases, Mayo Clinic, Rochester, MN, (4)Division Of Clinical Microbiology, Dept. Of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN

Disclosures:

T. Madigan, None

S. Vasoo, None

S. A. Cunningham, None

P. K. Tosh, None

R. Patel, Pfizer: Investigator, Research grant
Pradama : Investigator, Grant recipient
Astellas: Investigator, Grant recipient
Tornier: Investigator, Grant recipient
Pocared: Investigator, Research grant

P. Sampathkumar, None

R. Banerjee, None

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