LB-9. A Large and Primarily Community Associated Outbreak of Elizabethkingia anophelis Infections, Wisconsin, 2015-2016
Session: Oral Abstract Session: Late Breaker Oral Abstracts
Saturday, October 29, 2016: 11:50 AM
Room: 283-285
Background: Elizabethkingia anophelis, a rare gram-negative bacillus that is intrinsically multidrug-resistant, causes severe infections among persons with underlying medical conditions. On January 5, 2016 the Wisconsin Division of Public Health notified the Centers for Disease Control and Prevention of 6 E. anophelisbloodstream infections occurring among residents of 4 counties during the preceding 13 days. A joint investigation ensued.

Methods: A case was defined as an isolate of E. anophelis from any clinical specimen collected on or after November 1, 2015, with a pulsed field gel electrophoresis pattern matching the outbreak pattern. For each case-patient, we conducted a medical records review of all healthcare encounters during the 30 days before collection of the first positive specimen and an interview about community exposures. We assigned Charlson comorbidity scores. We evaluated potential sources and modes of transmission including but not limited to contaminated products (healthcare, personal care, food with regional distribution), tap water, environment (healthcare, residential), and person-to-person transmission.

Results: Sixty-three case-patients were identified among residents of 12 southeastern Wisconsin counties. Among patients, median age was 77 (range 19-101) years, 56% were male, median Charlson score was 3.5 (3-5), 25/48 (43%) had acute care admissions, 10/61 (14%) received hemodialysis and 18/63 (29%) patients died. Patients had healthcare encounters at 47 facilities; no facility was common to >7 patients. Healthcare and personal care products (N=41), tap water (N=29), and water-associated biofilm samples (N=61) were culture negative for the outbreak strain of E. anophelis, with the exception of 1 sample of standing water containing material used by a patient while ill. No food items were reported more frequently than expected. Surveillance cultures of 15 household contacts and 182 healthcare contacts were negative for E. anophelis.

Conclusions: This is the first report of a primarily community‚Äďassociated Elizabethkingia outbreak. Patients primarily were older adults with serious underlying medical conditions. The source and mode of transmission of the E. anophelis outbreak strain remain unknown.

Lina I Elbadawi, MD, MS1,2, Gwen Borlaug, CIC, MPH1, Kristin Gundlach, BS3, Timothy Monson, MS3, Judith Noble-Wang, PhD4, Heather Moulton-Meissner, PHD4, Uzma Ansari, MS4, Jonathan S. Yoder, MSW, MPH5, Matthew Wise, PhD5, John R Mcquiston, PhD6, Alexander Kallen, MD, MPH4, Jeffrey P Davis, MD1, Maroya Spalding Walters, PhD4 and Elizabethkingia Outbreak Investigation Team, (1)Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison, WI, (2)Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, (3)Wisconsin State Laboratory of Hygiene, Madison, WI, (4)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (5)Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, (6)Special Bacteriology Reference Laboratory, Centers for Disease Control and Prevention, Madison, WI

Disclosures:

L. I. Elbadawi, None

G. Borlaug, None

K. Gundlach, None

T. Monson, None

J. Noble-Wang, None

H. Moulton-Meissner, None

U. Ansari, None

J. S. Yoder, None

M. Wise, None

J. R. Mcquiston, None

A. Kallen, None

J. P. Davis, None

M. Spalding Walters, None

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