358. blaVIM-producing Enterobacter cloacae in Ontario, Canada: Links between Sewage, Surface Water, and Human Isolates
Session: Poster Abstract Session: HAI: Multi Drug Resistant Gram Negatives
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • VIM_Poster_12Oct2016.pdf (361.2 kB)
  • blaVIM-producing Enterobacter cloacae in

    Ontario, Canada: Links between Sewage,

    Surface Water, and Human Isolate

    Background:

    In Canada, carbapenemase-producing Enterobacteriaceae (CPE) are rare and usually imported from CPE-endemic countries. We report 2 patient clusters – none with hospitalizations abroad - of Verona integron-encoded metallo-β-lactamase producing Enterobacter cloacae (VIM-EC) linked to isolates from water in Ontario, Canada.

    Methods:

    We analyzed population-based data from Toronto Invasive Bacterial Diseases Network (TIBDN) surveillance from first identified CPE in 2007 until 3/2016 to identify VIM-EC colonized/infected patients. Sewage treatment plants (STP) and 1 watershed (WS) in the population area were sampled in 2015. Pulsed-field gel electrophoresis (PFGE) and plasmid sequencing (PS) was performed.

    Results:

    We identified 10 patients with VIM-EC; median age 76.5y; median Charlson score 2 (Table). Five developed a urinary tract infection; 1 a blood stream infection. Eight patients comprised 2 PFGE clusters: cluster I linked 4 patients from 3 hospitals to a WS sample and cluster II 4 patients from 2 hospitals to an STP sample (Fig 1, Fig 2). PS showed high similarity between plasmids from cluster II and the WS sample from cluster I, suggesting horizontal gene transfer. None of the 8 patients linked to a cluster had been hospitalized abroad, whereas the patient with a unique PFGE isolate had been hospitalized in Croatia.

    Conclusion:

    Most VIM-EC in Ontario is autochthonous, and water may be an important reservoir. More work is urgently needed to identify environmental reservoirs for CPE.  




    Table. Description of patient and water samples with VIM-EC.

    PATIENTS

    Water-shed

    Sewage

    PFGE type

    I

    I

    I

    I

    II

    II

    II

    II

    -

    III

    I

    II

    Plasmid type

    -

    -

    B

    B

    A

    A

    -

    -

    -

    -

    A

    A

    Patient #

    1

    2

    3

    4

    5

    6

    7

    8

    9

    10

    Sex

    F

    M

    M

    M

    M

    M

    F

    M

    F

    F

    Age 

    90

    76

    81

    88

    87

    65

    77

    65

    70

    24

    Charlson

    2

    2

    1

    2

    7

    5

    3

    4

    1

    0

    Inpatient days1

    60

    29

    38

    15

    22

    90

    7

    42

    207

    17

    Admission abroad1

    -

    -

    -

    -

    -

    -

    -

    -

    -

    Croatia

    Index hospital

    A

    B

    B

    C

    D

    D

    D

    D

    D

    E

    Date 1st isolate

    Aug 11

    Jul 11

    Feb 12

    Jun 12

    Feb 14

    Jun 14

    Jun 15

    Sep 15

    Jan 16

    Sep 12

    Body site

    U

    U

    U

    U

    R

    U

    PD

    PD

    R

    R

    VIM infection

    UTI

    UTI

    BSI, UTI

    -

    -

    UTI

    -

    -

    -

    UTI

    Length of stay

    21

    152

    47+

    33

    5+

    212

    6

    11

    276

    69

     1 within 1 year before detection; += died;  PD, Peritoneal Dialysis fluid; U, Urine; R, Rectal

    UTI, Urinary Tract Infection; BSI, Blood Stream Infection

    Philipp Kohler, MD1, Hyunjin Kim, BSc1, Roberto Melano, PhD2, Jennie Johnstone, MD3, Samir Patel, PhD2, Nathalie Tijet, PhD2, Barbara Willey, ART4, Brenda Coleman, PhD1, Karen Green, MSc1, Irene Armstrong, MD, MSc5, Kevin Katz, MD, CM, MSc, FRCPC6, Matthew P. Muller, MD, PhD, FRCPC7, Jeff Powis, MD, MSc, FRCPC8, Susan Poutanen, MD, MPH1, David Richardson, MD9, Alicia Sarabia, MD10, Andrew E. Simor, MD, FRCPC, FACP11 and Allison Mcgeer, MD, MSc1, (1)Mount Sinai Hospital, Toronto, ON, Canada, (2)Public Health Ontario Laboratories, Toronto, ON, Canada, (3)St. Joseph's Health Centre, Toronto, ON, Canada, (4)Department of Microbiology, Mount Sinai Hospital, Toronto, ON, Canada, (5)Toronto Public Health, Toronto, ON, Canada, (6)Department of Infection Control, North York General Hospital, Toronto, ON, Canada, (7)Medicine, St.Michael's Hospital, Toronto, ON, Canada, (8)Toronto East General Hospital, Toronto, ON, Canada, (9)William Osler Health Centre, Brampton, ON, Canada, (10)Credit Valley Hospital, Mississauga, ON, Canada, (11)Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Disclosures:

    P. Kohler, None

    H. Kim, None

    R. Melano, None

    J. Johnstone, None

    S. Patel, None

    N. Tijet, None

    B. Willey, None

    B. Coleman, None

    K. Green, None

    I. Armstrong, None

    K. Katz, None

    M. P. Muller, None

    J. Powis, GSK: Investigator , Research support

    S. Poutanen, Merck: Board Member , Honoraria and Speaker honorarium
    Paladin Labs: Board Member , Honoraria
    Accelerate Diagnostics: Board Member , Honoraria

    D. Richardson, None

    A. Sarabia, None

    A. E. Simor, None

    A. Mcgeer, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.