1619. Carbapenem-resistant Enterobacteriaceae (CRE) Klebsiella pneumonia (KP) Cluster Analysis
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • CRE KP SM 8.30.13 poster CAM 9.24.13 FINAL FINAL.pdf (716.3 kB)
  • Background: CRE Infections are a challenge in health-care. CRKP is the species most commonly encountered in the US and resistant to most antimicrobials.  Infections have been associated with high rates of morbidity and mortality.  The University of Pittsburgh Medical Center, Presbyterian (UPMC-P) is a 766-bed tertiary care facility and one of the largest solid organ transplantation programs in the US, performing >300 kidney, liver, intestinal and multi-visceral transplants per year. In 2012, CRKP incidence increased from 0.24 to 0.33; many patients had an Endoscopic Retrograde Cholangiopancreatography (ERCP) prior to (+) culture.  Our objective is to investigate the CRKP increase.

    Methods: 2011 – 2012 CRKP incidence and Hospital Acquired infections (HAI) were reviewed.  Targeted active surveillance testing (AST) was performed using HardyCHROM™ Carbapenemase media. 68 patients located on 4 GI/transplant floors were rectally screened.  Scope and washer manufacturers were notified and evaluated the cleaning/high level disinfection (C/HLD) process. GI lab/scopes were inspected, 31 scopes were cultured using previously described protocol. Usage document was obtained on implicated scope. Pulsed Field Gel Electrophoresis (PFGE) was done using Xbal as previously described. Results: CRKP HAI rates were not increased; however, many cases were present on admission in patients who had a recent GI procedure. AST – did not identify any additional colonized patients. C/HLD processes were reviewed with no issues. 5/31 (16%) scopes grew organisms consistent with GI flora.1/5 grew both Carbapenem sensitive (CS) KP and CRKP.

    Conclusion:

    ·         Scope related outbreaks due to HLD failure have been frequently reported.

    ·         2 CSKP clusters (types 1 and 2) and 1 CRKP cluster matched scope isolates.

    ·         AST did not identify any additional colonized, supporting lack of transmission on the patient care areas.

    ·         CRKP colonization/infection increase in GI Patients may have been associated with Scope 1160.

    µ  Majority of patients clustered with scope 1160

    ·         Of the 9/18 PFGE 3 cases were scoped with 1160

    ·         Of these 7/9 (78%) were identified post ERCP 1160

    ·          A case control study is underway to better understand association.

    Sheila Mccool, BSN, MPH, CIC, Infection Prevention and Hospital Epidemiology, UPMC, Pittsburgh, PA, Lloyd Clarke, B Sc (Hons), Pharmacy/Infectious Diseases, UPMC, Pittsburgh, PA, Ashley Querry, BS, Infection Prevention & Hospital Epidemiology, University of Pittsburgh Medical Center - Presbyterian Hospital, Pittsburgh, PA, Anthony Pasculle, ScD, University of Pittsburgh Medical Center, Pittsburgh, PA, Laurie Rack, DNP, RN, NEA-BC, Patient Support Services, University of Pittsburgh Medical Center - Presbyterian University Hospital, Pittsburgh, PA, Chad Neilsen, BS, MPH, Infection Prevention and Hospital Epidemiology, University of Pittsburgh Medical Center-Presbyterian Hospital, Pittsburgh, PA and Carlene Muto, MD, MS, FSHEA, Infection Prevention & Hospital Epidemiology, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, PA

    Disclosures:

    S. Mccool, None

    L. Clarke, None

    A. Querry, None

    A. Pasculle, None

    L. Rack, None

    C. Neilsen, None

    C. Muto, None

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