Methods: Active, laboratory- and population-based surveillance was established in 2013 with program staff contacting all laboratories that serve providers in Bernalillo County, NM. Queries were set up on laboratories’ automated testing instruments (ATIs) to detect carbapenem- and extended-spectrum cephalosporin resistant E. coli, Enterobacter aerogenes, Enterobacter cloacae, Klebsiella pneumoniae, Klebsiella oxytoca, or carbapenem-nonsusceptible Acinetobacter baumannii complex isolated from normally sterile sites or urine. Medical record reviews were conducted on incident cases, and a convenience sample of isolates underwent additional analyses.
Results: From January 1, 2013 – December 31, 2014, 47 MuGSI cases were identified from 16 unique providers. All but one were from urine cultures. Half were aged 65 or older, and three-quarters were female. While cases were identified from across the spectrum of care, half were collected in outpatient settings. Two-thirds had at least one risk factor related to healthcare exposures, indwelling devices, or travel; nearly half had been hospitalized in the prior year. A third were hospitalized at the time of, or within 30 days after culture; among those, 70% were discharged to a long-term care facility. Most had mild clinical presentations, and outcomes were generally good. Two Klebsiella pneumoniae carbapenemase (KPC)-producing organisms were identified.
Six cases were identified in 2013 and 41 in 2014. Most cases were identified by the largest laboratory in the area; an audit for 2013 was conducted for this laboratory with one additional case detected. No changes in protocol or staffing had occurred that would be expected to impact identification or reporting.
Conclusion: The number of MuGSI cases identified in Bernalillo County residents increased six-fold from 2013 to 2014; this was not explained by changes in laboratory practices or reporting, and the largest increase was seen in the outpatient setting. Most cases had at least one risk factor and most had good outcomes. Two KPC-producing organisms were identified in this population.
E. C. Phipps,
N. Kenslow, None
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