349. Carbapenem resistant Enterobacteriaceae (CRE) in the Veterans Health Administration (VHA): a “second epidemic” of carbapenem resistance among Enterobacter cloacae after that of Klebsiella pneumoniae
Session: Poster Abstract Session: HAI: Multi Drug Resistant Gram Negatives
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Slide1.GIF (1.2 MB)
  • Background: CRE/carbapenemase producing Enterobacteriaceae (CPE) is a serious threat to public health. The “first epidemic” of CRE/CPE in the US was caused by K. pneumoniae producing KPC-2 and 3. A “second epidemic”, E. cloacae harboring KPC-3, first occurred in North Dakota and Minnesota. We examined rates and temporal trends of carbapenem non-susceptibility (NS) in K. pneumoniae and E. cloacae at VHA facilities.

    Methods: Using VHA databases, we identified E. cloacae and K. pneumoniae tested for carbapenem susceptibility isolated in patients hospitalized from 2012 to 2014. Facilities that tested < 90% of isolates were excluded; one isolate per patient was counted. We examined carbapenem NS by year, sorting facilities according to regions designated by the US Department of Health and Human Services.

    Results: Among 10,973 E. cloacae and 28,218 K. pneumoniae isolates from VHA facilities in 42 states, the District of Columbia (DC), and Puerto Rico (PR), carbapenem NS was 3.3% and 2.8% for E. cloacae and K. pneumoniae, respectively. Rates among E. cloacae trended upwards to reach above 3% and rates in K. pneumoniae decreased from 3.3% to 2.1% over the 3 years examined. Trends remained after removing PR, which had the highest rates at 12.2% and 23.3%, respectively. The rate of carbapenem NS in E. cloacae exceeded that of K. pneumoniae in all regions except Region 2 (Table and Maps). Despite these regional trends, there were exceptions in several large cities outside of Region 2 with higher rates of NS in K. pneumoniae than in E. cloacae.

    Conclusion: Nationwide VHA data suggests a “second epidemic” of CRE/CPE mediated by E. cloacae. Robust surveillance integrating susceptibility data, resistance mechanisms, genotyping and antibiotic use is essential to understand the changing epidemiology of CRE/CPE in the VHA system.

    Region

    States

    E. cloacae

    K. pneumoniae

     

     

    Range of % NS *

    % NS

    Range of % NS *

    % NS

    1

    ME, VT, RI, MA

    0-3.1

    2.5

    0-0.9

    0.10

    2

    NY, NJ, PR

    1.0 -12.3

    6.1

    0.8-23.5

    12.1

    3

    VA, PA, MD, WV, DC

    0-5.8

    2.4

    0-4.8

    2.1

    4

    AL, GA, MS, NC, SC, TN, FL

    0-5.9

    2.6

    0-3.4

    1.0

    5

    IL, IN, MI, MN, OH, WI

    0-6.9

    1.9

    0-4.3

    1.8

    6

    AR, LA,  OK, TX

    0-8

    3.4

    0-4.7

    1.9

    7

    IA, KS, MO, NE

    0-4

    1.6

    0-3.8

    0.8

    8

    CO, SD, ND, MT, UT, WY

    0-4

    1.9

    0-0

    0.2

    9

    AZ, CA, NV

    0-11.3

    4.0

    0-3.4

    1.5

    10

    OR, WA

    0-15.1

    8.9

    0-0.6

    0.3

     

     

     

     

     

     

     

     

     

    Including facilities with > 30 isolates

      

      

    Federico Perez, MD1,2, Brigid Wilson, PhD3, Sachin Patel, MD2, Elie Saade, MD, MPH4, Curtis J. Donskey, MD5 and Robert A. Bonomo, MD6, (1)Medicine Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, (2)Case Western Reserve University, Cleveland, OH, (3)Geriatric Research, Education, and Clinical Center, Cleveland Vet. Medical Center, Cleveland, OH, (4)Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, (5)Infectious Diseases, Case Western Reserve University, Cleveland, OH, (6)Pharmacology, Molecular Biology, and Microbiology, Case Western Reserve University, Cleveland, OH

    Disclosures:

    F. Perez, Pfizer: Grant Investigator , Grant recipient
    Actavis: Consultant , Consulting fee

    B. Wilson, None

    S. Patel, None

    E. Saade, None

    C. J. Donskey, None

    R. A. Bonomo, 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.