337. Two years of Population-based Surveillance for Carbapenem-resistant Enterobacteriaceae (CRE) in Bernalillo County, NM, 2014-2015
Session: Poster Abstract Session: HAI: Multi Drug Resistant Gram Negatives
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Phipps_IDWeek_2016_Final.pdf (317.2 kB)
  • Background: Carbapenem-resistant Enterobacteriaceae (CRE) present treatment and infection control challenges. CRE can be transmitted in healthcare settings, and invasive infections can cause high mortality.

    Methods: Active, laboratory- and population-based surveillance was conducted in Bernalillo County, NM. We defined CRE as Escherichia coliEnterobacter spp, or Klebsiella spp nonsusceptible to ≥1 carbapenem (excluding ertapenem) and resistant to all 3rd generation cephalosporins tested, and CRAB as A. baumannii nonsusceptible to ≥1 carbapenem (excluding ertapenem) isolated from normally sterile sites or urine. Medical record reviews were conducted on incident cases, and a convenience sample of isolates underwent PCR for common carbapenemases at CDC.

    Results: From January 1, 2014 – December 31, 2015, 85 cases were identified; half were collected in outpatient settings. Three were isolated from blood and 82 from urine. Half of the patients were aged 62 or older, and nearly three-quarters were female. Eleven percent were American Indian/Alaska Native (AIAN), twice that of the Bernalillo County population.

    Two-thirds had risk factors 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, 40% were discharged to a long-term care facility (LTCF).

    Four Klebsiella pneumoniae carbapenemase (KPC)-producing organisms were identified among 48 isolates tested (8.3%): one E. aerogenes, one E. cloacae, and two K. pneumoniae. Two KPC+ specimens were collected in outpatient settings, one from a long-term acute care hospital (LTACH), and one from a LTCF. All four patients had been hospitalized in the year prior, three had been in a LTCF, and one in both a LTCF and LTACH.

    Conclusion: Although the majority of isolates were collected from outpatient settings, most patients had extensive healthcare exposures in the prior year. Females and AIAN were overrepresented. Four of 48 (8.3%) of isolates submitted were carbapenemase producers; those individuals all had extensive healthcare exposures. Inter-facility communication among both inpatient and ambulatory settings is vital to limit CRE transmission.

    Erin C. Phipps, DVM, MPH1,2, Nicole Kenslow, MPH1,3 and Emily B. Hancock, MS1,2, (1)New Mexico Emerging Infections Program, Albuquerque, NM, (2)University of New Mexico, Albuquerque, NM, (3)Health Sciences Center, University of New Mexico, Albuquerque, NM

    Disclosures:

    E. C. Phipps, None

    N. Kenslow, None

    E. B. Hancock, 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.