330. Molecular Epidemiology and Outcomes of Carbapenem Non-Susceptible (CARB-NS) Clinical Isolates in Detroit
Session: Poster Abstract Session: HAI: Multi Drug Resistant Gram Negatives
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • veve_molEpi_outcomes.pdf (284.3 kB)
  • Background: The emergence and spread of carbapenem resistant organisms is a significant burden to healthcare systems worldwide. We describe the molecular bla identified in carbapenem non-susceptible (CARB-NS) isolates found in our institution and the characteristics of infected patients.

    Methods: A cohort of CARB-NS clinical blood, urine, respiratory tract and other isolates were evaluated from 1/2013 to 12/2015. Whole genomic DNA from CARB-NS Enterobacteriaceae (EB) and Pseudomonas sp. (PS) was purified before undergoing real-time polymerase chain reaction using SYBR Green (Bio-Rad). Primers and control organisms (CDC, Georgia) for bla sequences (NDM, KPC, VIM, SME, GES, IMP) were confirmed using melt-curve analyses relative to control organisms. Patient characteristics, treatment and outcomes were extracted from electronic medical records using a standardized case report form.

    Results: 161 isolates were screened for carbapenemase production; EB 90 (56%), PS 71 (44%). 55 (34%) were found to harbor blaKPC (EB 50, 91%; PS 5, 9%). All other bla tested were non-confirmatory. Of unique isolates, variables independently associated with blaKPC were: male sex (OR, 0.3; 95% CI, 0.13-0.71), active hematological disease (OR, 3.3; 95% CI, 1.2-8.9), as seen in Table 1. Previous 5-year history of ESBL or CRE was not associated with blaKPC . Of 43 unique patients with confirmed blaKPC, 28 (65%) were treated with systemic antibiotics. The most common infection sites were: bloodstream (50%), urinary tract (25%). 50% of patients had multiple infection sites. Most common organisms causing infection were: K. pneumonia (56%) and E. coli (14%). For all non-urinary tract infections, monotherapywas employed more frequently than combination therapy for both initial (68% vs. 32%) and definitive treatment (56% vs. 44%). 6-month all-cause mortality for treated patients was 57%.

    Conclusion: Carbapenemase production was not frequently identified in CARB-NS isolates, but the predominate bla­-sequence was KPC. Treatment regimens varied widely. An understanding of CARB-NS regional genomic sequencing is beneficial for clinicians to target appropriate antibiotic therapy and improve infection control procedures.

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    Michael Veve, PharmD1, Jeremy Delor, PharmD student2, Robert Tibbetts, Ph.D. D(ABMM), F(CCM)3 and Susan L Davis, PharmD1, (1)Wayne State University College of Pharmacy, Detroit, MI, (2)Henry Ford Hospital, Detroit, MI, (3)Pathology and Microbiology, Henry Ford Hospital, Detroit, MI

    Disclosures:

    M. Veve, None

    J. Delor, None

    R. Tibbetts, None

    S. L. Davis, 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.