1380. Bacteremia due to Carbapenem-resistant Enterobacteriaceae (CRE) in New York and New Jersey: A Clinical and Molecular Epidemiologic Analysis
Session: Oral Abstract Session: Epidemiology of Resistant Gram Negative Infections
Saturday, October 10, 2015: 11:00 AM
Room: 5--AB
Background: CRE bacteremia has been associated with mortality rates of 50%. The New York/New Jersey (NY/NJ) area has been an epicenter for CRE for over a decade, primarily due to Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp), but there have been no multi-institutional studies describing the clinical and molecular epidemiology of CRE in this region.

Methods: We reviewed all CRE bacteremia episodes in 2013 (first per patient) at eight institutions in the NY/NJ area and assessed patient characteristics, treatments and outcomes. Carbapenem resistance was defined as non-susceptibility to imipenem or meropenem and CRE isolates underwent multilocus sequence typing (MLST) and PCR for carbapenemase genes. Factors associated with 30-day mortality were identified by logistic regression, including the use of ≥2 CRE-active drugs or a carbapenem in the definitive antimicrobial regimen. 

Results: There were 131 patients with CRE bacteremia, of which 111 (85%) were due to Kp. BlaKPC was detected in 94% of Kp (KPC-3: 48%; KPC-2: 46%), and of these, 88% were ST 258. One blaOXA-48 and one blaNDM-1 were also detected. All but four patients were adults and the median age was 65. Bacteremia onset occurred more frequently outside of the hospital (34%) than in the ICU (24%), including in 24 patients (18%) whose infection began at home. Forty percent of patients had cancer and 24% had an endoscopic procedure within the previous 30 days. There was a median of 45 hours from bacteremia onset until receipt of an antimicrobial agent to which the CRE tested susceptible. Septic shock occurred within two days of bacteremia onset in 36% of patients. The 30-day mortality rate was 46% and there was a median of 10 days from bacteremia onset to death. In multivariate analysis, having a urinary source was associated with decreased mortality (odds ratio [OR] 0.26, P=0.03), while having an unknown source (OR 3.51, P=0.04), cancer (OR 2.67, P=0.03) and being in an ICU (OR 3.58, P=0.02) were associated with increased mortality. Neither the use of combination therapy nor a carbapenem in the definitive regimen was associated with survival.

Conclusion: ST 258 KPC-Kp remains the dominant CRE in the NY/NJ area. Despite over a decade of experience with these pathogens, CRE bacteremia is still associated with suboptimal initial therapy and 30-day mortality rates that approach 50%.

Michael Satlin, MD, MS1, Liang Chen, PhD2, Gopi Patel, MD, MS3, Angela Gomez-Simmonds, MD4, Gregory Weston, MD5, Angela Kim, MD6, Susan Seo, MD7, Marnie Rosenthal, DO, MPH8, Steven Sperber, MD9, Stephen Jenkins, PhD1, Anne-Catrin Uhlemann, MD, PhD4, Michael Levi, ScD, (D) ABMM5, Bettina Fries, MD5, Yi-Wei Tang, MD PhD, FIDSA7, Stefan Juretschko, PhD6, Albert Rojtman, MD8, Tao Hong, PhD9, Barun Mathema, PhD, MPH2, Thomas Walsh, MD, FIDSA1 and Barry N. Kreiswirth, PhD2, (1)New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, (2)Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ, (3)Mount Sinai Hospital, New York, NY, (4)New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, (5)Montefiore Medical Center, Bronx, NY, (6)North Shore-LIJ Health System, Manhasset, NY, (7)Memorial Sloan Kettering Cancer Center, New York, NY, (8)Jersey Shore University Medical Center, Neptune, NJ, (9)Hackensack University Medical Center, Hackensack, NJ

Disclosures:

M. Satlin, None

L. Chen, None

G. Patel, None

A. Gomez-Simmonds, None

G. Weston, None

A. Kim, None

S. Seo, None

M. Rosenthal, None

S. Sperber, None

S. Jenkins, None

A. C. Uhlemann, None

M. Levi, None

B. Fries, None

Y. W. Tang, None

S. Juretschko, None

A. Rojtman, None

T. Hong, None

B. Mathema, None

T. Walsh, None

B. N. Kreiswirth, None

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