336. Epidemiology of the emergence of Carbapenemase-producing Enterobacteriaceae in South-central Ontario, Canada
Session: Poster Abstract Session: HAI: Multi Drug Resistant Gram Negatives
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • CPE_Poster_12Oct2016.pdf (277.2 kB)
  • Epidemiology of the emergence of

    Carbapenemase-producing Enterobacteriaceae in

    South-central Ontario, Canada

    Background:

    Carbapenemase-producing Enterobacteriaceae (CPE) are an increasing threat. Here, we describe the CPE epidemiology in Southern Ontario, Canada.

    Methods:

    We analyzed Toronto Invasive Bacterial Diseases Network (TIBDN) population-based surveillance data from first isolates in 10/2007 to 4/2016. Patients diagnosed after 1/2013 were asked to participate in a prospective cohort, where they were asked for healthcare visits/travel abroad.

    Results:

    We identified 270 CPE patients with a median age of 70 years (Table). The incidence increased from 0 in 2006 to 1.1/100 000 in 2015. The most frequent species and enzyme were Klebsiella pneumoniae and New Delhi metallo-β-lactamase (NDM). Incidence and distribution varied significantly in adjacent urban areas (Figs 1, 2). Of 103 (38%) patients with a CPE infection, 74 (72%) had urinary tract infection, and 24 (23%) blood stream infection. Overall in-hospital mortality was 16%. Among 77 prospectively enrolled patients, healthcare in the Indian subcontinent 1 year prior to CPE identification was reported by 26/45 (58%) patients with NDM compared to 4/32 (13%) with non-NDM CPE (P < 0.001). Among patients with non-NDM CPE, 18/32 (56%) reported no healthcare abroad or travel to the Indian subcontinent (Fig 3).

    Conclusion:

    CPE are increasing in Southern Ontario. Incidence and risk factors differ clearly by geography. A majority of patients with non-NDM CPE appear to have acquired their CPE in a Canadian hospital.





    Table. Characteristics of patients colonized/infected with Carbapenemase-producing Enterobacteriaceae (CPE). Numbers are n (%) if not stated otherwise.

    N=270

    N=270

    Characteristics

    Antibiotics in last year

    Male sex

    172 (64)

    Any

    175 (65)

    Age in years, median (IQR)

    70.6 (21)

    3rd/4th generation Cephalosporins

    71 (26)

    Charlson, median (IQR)

    1 (3)

    Carbapenems

    32 (12)

    Diabetes

    114 (42)

    Quinolones

    75 (28)

    Cancer

    43 (16)

    Site

    Dialysis

    34 (12)

    Rectal

    157 (58)

    Exposures in last year

    Urine

    78 (29)

    Hospital admission > 48h

    209 (77)

    Blood

    11 (4)

    Intensive care

    67 (25)

    Outcome

    Surgery

    93 (34)

    CPE infection

    103 (38)

    Central venous catheter

    69 (26)

    Urinary tract infection

    74 (27)

    Blood transfusion

    49 (18)

    Blood stream infection

    24 (9)

    Foley catheter

    104 (39)

    Overall in-hospital death

    44 (16)

    Philipp Kohler, MD1, Roberto Melano, PhD2, Samir N. Patel, PhD, FCCM3, Shumona Shafinaz, MD1, Amna Faheem, MD1, Brenda L. Coleman, PhD4, Karen Green, MSc1, Irene Armstrong, MD, MSc5, Huda Almohri, BSc, MD, FRCPC6, Kevin Katz, MD, CM, MSc, FRCPC7, Freda Lam, MPH, CPHI(C)8, Matthew Muller, MD, PhD9, Jeff Powis, MD, MSc, FRCPC10, Susan Poutanen, MD, MPH1, David Richardson, MD11, Laura Rosella, PhD12, Anu Rebbapragada, PhD13, Alicia Sarabia, MD14, Andrew Simor, MD15 and Allison Mcgeer, MD, MSc1, (1)Mount Sinai Hospital, Toronto, ON, Canada, (2)Public Health Ontario Laboratories, Toronto, ON, Canada, (3)Public Health Laboratory-Toronto, Public Health Ontario, Toronto, ON, Canada, (4)Infectious Disease Epidemiology Research Unit, Mount Sinai Hospital, Toronto, ON, Canada, (5)Toronto Public Health, Toronto, ON, Canada, (6)LifeLabs, Toronto, ON, Canada, (7)Department of Infection Control, North York General Hospital, Toronto, ON, Canada, (8)Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada, (9)St. Michael's Hospital, Toronto, ON, Canada, (10)Toronto East General Hospital, Toronto, ON, Canada, (11)William Osler Health Centre, Brampton, ON, Canada, (12)Public Health Ontario, Toronto, ON, Canada, (13)Gamma Dynacare, Toronto, ON, Canada, (14)Credit Valley Hospital, Mississauga, ON, Canada, (15)Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Disclosures:

    P. Kohler, None

    R. Melano, None

    S. N. Patel, None

    S. Shafinaz, None

    A. Faheem, None

    B. L. Coleman, None

    K. Green, None

    I. Armstrong, None

    H. Almohri, None

    K. Katz, None

    F. Lam, None

    M. 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

    L. Rosella, None

    A. Rebbapragada, None

    A. Sarabia, None

    A. 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.