1381. The Movement of Carbapenem-Resistant Klebsiella pneumoniae (CRKP) among Healthcare Facilities: A Network Analysis
Session: Oral Abstract Session: Epidemiology of Resistant Gram Negative Infections
Saturday, October 10, 2015: 11:15 AM
Room: 5--AB

Background:   Understanding the movement of patients harboring carbapenem-resistant K. pneumoniae (CRKP) within healthcare systems is important to control this epidemic. Here, we applied network analysis to data from the Consortium on Resistance against Carbapenems in K. pneumoniae (CRaCKle) to frame future infection control (IC) strategies.

Methods:   CRaCKle is a prospective multicenter study. All admissions were included for patients who had a positive clinical culture for CRKP during a hospitalization between 12/24/2011 and 10/1/2014.  Repetitive extragenic palindromic (rep)-PCR was performed using the DiversiLab Strain typing system.  Isolates with ≥ 95% similarity were considered of the same rep-PCR type.  In facility-level network analysis, facilities that send/receive to a single setting are collapsed (empty circle, numbered correspondingly to number of facilities).  Edge values are the number of patients who move from node to node (summed within strain type), node size is proportional to the sum of these edges. Edge color is the strain (gray is un-typed). In the patient-level analysis, nodes are shaded red to yellow from beginning to end of study period, node and edge size are proportional to number of neighbors, and time jointly exposed, respectively.

Results:   During the study period, 522 patients (median age 69 years, IQR 57-79, 57% female, 57% White, 40% Black) had a total of 708 admissions at 14 hospitals.  121 (23%) patients were admitted more than once.  177/522 (34%) patients had at least one CRKP strain typed by rep-PCR; ST258A (61/177, 34%) and ST258B (77/177, 44%) were the most common types.  The number of admissions per hospital varied widely between 2 and 236 admissions.  Patients were admitted from and discharged to a total of 195 different facilities (Figure 1). Patient-level analysis (Figure 2) shows an ongoing continuous epidemic with several examples of highly connected patients.

Conclusion:   Network analysis models the dynamics of CRKP movement (blaKPC2,-3 in ST258A and-B), and indicates complex connectivity.  High connectivity levels may facilitate CRKP transmission, and suggest that IC strategies for CRKP must be regional or national and incorporate both horizontal (hand hygiene) and vertical (active surveillance) approaches.

David Van Duin, MD, PhD1, Federico Perez, MD2,3, Eric Cober, MD4, Sandra S. Richter, MD, FIDSA5, Robert Kalayjian, MD6, Robert Salata, MD, FIDSA7, Nikole Scalera, MD, MS8, Richard R. Watkins, MD, MS, FACP9, Yohei Doi, MD, PhD10, Scott Evans, PhD, MS11, Vance G. Fowler Jr., MD12, Keith Kaye, MD, MPH, FIDSA, FSHEA13, Susan D. Rudin, BS14, Kristine M. Hujer, BS3, Andrea M. Hujer, BS14, Robert Bonomo, MD15, James Moody, PhD16,17 and Antibacterial Resistance Leadership Group, (1)Infectious Diseases, University of North Carolina, Chapel Hill, NC, (2)Cleveland VAMC Case Western Reserve University, Cleveland, OH, (3)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (4)Infectious Disease, Cleveland Clinic, Cleveland, OH, (5)Laboratory Medicine, Cleveland Clinic, Cleveland, OH, (6)Infectious Diseases, The Metrohealth Medical Center, Cleveland, OH, (7)University Hospitals Case Medical Center, Cleveland, OH, (8)Summa Health, Akron, OH, (9)Infectious Diseases, Akron General Medical Center, Akron, OH, (10)University of Pittsburgh Medical Center, Pittsburgh, PA, (11)Harvard University, Boston, MA, (12)Duke University Medical Center, Durham, NC, (13)Medicine, Wayne State University, Detroit, MI, (14)Case Western Reserve University, Cleveland, OH, (15)Pharmacology, Molecular Biology, and Microbiology, Case Western Reserve University, Cleveland, OH, (16)Duke University, Durham, NC, (17)King Abdulaziz University, Jeddah, Saudi Arabia


D. Van Duin, Sanofi-Pasteur: Consultant , Consulting fee
Scynexis: Investigator , Research support

F. Perez, None

E. Cober, None

S. S. Richter, BD diagnostics: Investigator , Research support
OpGen: Investigator , Research support
bioMerieux: Investigator , Research support
Nanosphere: Investigator , Research support
Cerexa: Investigator , Research support
Pocared: Investigator , Research support
Biofire: Investigator , Research support
Achaogen: Investigator , Research support

R. Kalayjian, None

R. Salata, None

N. Scalera, None

R. R. Watkins, None

Y. Doi, Shionogi: Scientific Advisor , Consulting fee
Merck: Investigator , Research grant
Melinta: Consultant , Consulting fee

S. Evans, Soceity for Clinical Trials: Board Member , Unpaid
Fogarty: Grant Investigator , Salary
NIAID / NIH: Grant Investigator , Salary
Takeda/Millennium: Scientific Advisor , Consulting fee
Pfizer: Scientific Advisor , Consulting fee
Roche: Scientific Advisor , Consulting fee
Novartis: Scientific Advisor , Consulting fee
Achaogen: Scientific Advisor , Consulting fee
Alcon: Scientific Advisor , Consulting fee
Merck: Scientific Advisor , Consulting fee
Chelsea: Scientific Advisor , Consulting fee
Mannkind: Scientific Advisor , Consulting fee
QRx Pharma: Scientific Advisor , Consulting fee
IMMPACT: Scientific Advisor , Speaker honorarium
Genentech: Scientific Advisor , Consulting fee
Affymax: Scientific Advisor , Consulting fee
FzioMed: Scientific Advisor , Consulting fee
Auspex: Scientific Advisor , Consulting fee
Amgen: Scientific Advisor , Consulting fee
GSK: Scientific Advisor , Consulting fee
Boehringer-Ingelheim: Scientific Advisor , Consulting fee
American Statistical Association: Speaker , Speaker honorarium
FDA: Scientific Advisor , Speaker and Avisory honoaria
Osaka University: Speaker / teacher , Speaker honorarium
City of Hope: Speaker , Speaker honorarium
National Cerebral and Cardiovascular Center of Japan: Speaker , Speaker honorarium
PMDA (Japan): Speaker , Speaker honorarium
Drug Information Association: Speaker , Speaker honorarium
CITI: Speaker , Travel expenses
PPRECISE: Scientific Advisor , Speaker honorarium
Degruyter: Editor-in-Chief , Editor honoraria

V. G. Fowler Jr., Merck: Investigator and Scientific Advisor , Consulting fee and Research support
Pfizer: Consultant and Investigator , Consulting fee and Research support
Novartis: Consultant and Investigator , Consulting fee and Research support
Galderma: Consultant , Consulting fee
Novadigm: Consultant , Consulting fee
Durata: Consultant , Consulting fee
Debiopharm: Consultant , Consulting fee
Genentech: Consultant , Consulting fee
Achaogen: Consultant , Consulting fee
Affinium: Consultant , Consulting fee
Medicines Co.: Consultant , Consulting fee
Cerexa: Consultant and Investigator , Consulting fee and Research support
Tetraphase: Consultant , Consulting fee
Trius: Consultant , Consulting fee
MedImmune: Consultant and Investigator , Consulting fee and Research support
Bayer: Consultant , Consulting fee
Theravance: Consultant and Investigator , Consulting fee and Research support
Cubist: Consultant and Investigator , Consulting fee and Research support
Basilea: Consultant , Consulting fee
Advanced Liquid Logics: Investigator , Research support
Green Cross: educational development , Consulting fee

K. Kaye, Detroit Medical Center and Wayne State University: Consultant and Grant Investigator , Consulting fee and Grant recipient

S. D. Rudin, None

K. M. Hujer, None

A. M. Hujer, None

R. Bonomo, None

J. Moody, b) James S. McDonnell Foundation: Grant Investigator , Grant recipient

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.