1795. Brain and Spinal Cord Injury Patients with Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae: Prevalence and Potential for Prolonged Colonization
Session: Poster Abstract Session: Resistant Gram-Negative Infections: CRE Epidemiology
Saturday, October 10, 2015
Room: Poster Hall
Background:

Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) is highly antibiotic-resistant and poses a serious threat to patients (pts) and to healthcare systems. Since our first KPC-KP was identified in early 2009, we noted that a significant number of patients with brain and spinal cord injuries (BSCIs) were present in our KPC-KP population. We studied the prevalence of BSCI pts among our KPC-KPs, investigated clinical characteristics, and analyzed the strains recovered from these patients.

Methods:

A retrospective cohort study was performed at Northwestern Memorial Hospital (NMH) to identify all KPC-KP cases from February 2009 to December 2014. Electronic medical records were reviewed to determine the clinical characteristics including demographics, underlying conditions, time from admission to KPC-KP isolate, number of prior admissions, culture site, and duration of colonization. KPCs was confirmed by KPC-specific polymerase chain reaction (PCR). Patients with multiple KPC-KPs were defined as those with KPC-KP isolates detected in different calendar months. Two archived KPC-KP isolates recovered from separate cultures of the same patient were compared with pulsed field gel electrophoresis (PFGE) and used to calculate the duration of colonization.

Results:

Of 218 pts with KPC-KP, 86 (39%) were BSCI pts. Of these 27 (31%) had multiple KPC-KPs, and 20 (74%) pt’s isolates were available for analysis. Of these 20, average age was 45 yrs, 15 (75%) were male, 15 (75%) were African American, and average Charlson score was 3.5 (range 2-13). The majority (n=17; 85%) of pts had SCI. The average time from admission to KPC-KP detection was 1.5 d (range 0-11 days), and the average number of prior admissions to NMH was15 (range 0-82). KPC-KP isolates were from urine in 17 (85%), blood 1 (5%), surveillance culture 1 (5%) and blood and surveillance culture 1 (5%). Thirteen (65%) patients were infected or colonized with the same strain type over time, and the strain persisted on average 372 days.

Conclusion:

BSCI patients comprise a significant percentage of our KPC-KP population. Due to repeated hospitalizations and prolonged colonization, they represent a substantial reservoir for these multidrug-resistant pathogens.

Nicholas Zembower, NA, Lyons Township High School, La Grange, IL, Alex Zhu, none, Walter Payton College Prep, Chicago, IL, Michael Malczynski, BS, Microbiology, Northwestern Memorial Hospital, Chicago, IL and Chao Qi, PhD, Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL

Disclosures:

N. Zembower, None

A. Zhu, None

M. Malczynski, None

C. Qi, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.