1606. Characteristics of Carbapenem-resistant Enterobacteriaceae-positive Patients in Oregon
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) are an emerging public health problem.  This review was performed to better understand statewide CRE epidemiology and characteristics of CRE-positive patients.   

Methods:

Mandatory reporting of CRE in Oregon began in December 2011. We reviewed medical records of all patients with CRE-positive cultures reported to the Oregon Health Authority through March 2013.  Patient demographics and risk factors for CRE were analyzed.  Carbapenemase production was assessed via Modified Hodge Test (MHT) and PCR for Klebsiella pneumoniae carbapenemase (KPC) and New Delhi metallo-beta-lactamase (NDM).

Results:

CRE were reported in 49 patients; median age was 65 (IQR 48, 76) and the majority were female (n=32; 65%).  Most patients (n=31; 63%) were hospitalized at the time cultures were obtained; other healthcare settings from which CRE were isolated included outpatient clinics (n=12; 25%), emergency departments or urgent care (n=4; 8%), and long-term care facilities (n=2; 4%).  Culture site and results of carbapenemase testing arranged by species are summarized in the Table.

 

Organism

Number

Culture Site

Carbapenemase Testing

Urine

Blood

Respiratory

Wound

MHT+

KPC +

Enterobacter cloacae

26

20

3

1

2

16

0

Klebsiella pneumoniae

9

6

1

0

2

4

3

Enterobacter aerogenes

8

6

1

1

0

3

0

Escherichia coli

2

2

0

0

0

0

0

Citrobacter spp

1

1

0

0

0

1

0

Serratia marcescens

1

0

1

0

0

0

0

Proteus mirabilis

1

1

0

0

0

ND

0

Enterobacter spp

1

1

0

0

0

0

0

Total

49

37(76%)

6(12%)

2(4%)

4(8%)

24(49%)

3(6%)

PCR testing for NDM was negative in all isolates. The three patients harboring KPCs were not epidemiologically linked, and each had received recent healthcare outside Oregon.

Conclusion:

CRE reported in Oregon are predominantly Enterobacter spp. isolated from the urine of hospitalized patients or outpatients, and are not carbapenemase-producers.  The paucity of reported carbapenemase-producing CRE indicates that these organisms are pre-emergent in Oregon.  This presents a unique opportunity for a coordinated regional approach to rapidly detect and prevent the spread of CRE in a low-prevalence setting.

 

Andrew Leitz, MD1, Margaret Cunningham, MPH2, Tasha Poissant, MPH2, Ann Thomas, MD, MPH2, J. Townes, MD1, Jon Furuno, PhD1,3, Zintars G. Beldavs, MS2 and Christopher Pfeiffer, MD1,4, (1)Oregon Health & Science University, Portland, OR, (2)Oregon Health Authority, Portland, OR, (3)Oregon State University, Portland, OR, (4)Portland VA Medical Center, Portland, OR

Disclosures:

A. Leitz, None

M. Cunningham, None

T. Poissant, None

A. Thomas, None

J. Townes, None

J. Furuno, None

Z. G. Beldavs, None

C. Pfeiffer, None

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