347. The importance of ventilator skilled nursing facilities (vSNFs) in the regional epidemiology of carbapenemase-producing organisms (CPOs)
Session: Poster Abstract Session: HAI: MDRO-GNR/Emerging Resistant Bacterial Pathogens
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • Abstract347_IDWeek2017_vSNF_Poster_v0.4_Final.pdf (311.5 kB)
  • Background: Patients in long term acute care hospitals (LTACHs) in the Chicago region have high prevalence of CPO carriage (in previous point prevalence surveys, ~30%). vSNFs care for a similarly ill population and often receive patient transfers from LTACHs. Based on these observations and our results from an earlier study, we hypothesized that vSNFs are reservoirs of CPO-positive patients.

    Methods: During October 2016 – May 2017, all 8 vSNFs in the Chicago region were invited to participate in one day point prevalence surveys of residents on their skilled nursing and ventilator wards. Local staff obtained a rectal swab from each resident and collected de-identified patient information assessed at time of survey (age, sex, respiratory support status, length of stay, contact precautions status, facility awareness of resident CPO status). Swabs were processed at a central lab within 6 hours of collection. Overnight growth from MacConkey agar plates was screened, using two commercial multiplex PCR assays (Acuitas® MDRO gene test, Acuitas Resistome test; OpGen, Gaithersburg, MD) for 5 carbapenemase gene families (KPC, NDM, VIM, IMP & OXA-48).

    Results: Seven of 8 vSNFs and 585 (90%) of 648 eligible residents participated (Table 1). Overall, CPO prevalence was 27% (range, 9% to 37%) and higher in ventilator wards (40%) than skilled wards (10%), P<0.001. Colonized patients often were not on contact precautions and not recognized by the facility to have CPO carriage (Table 1). The majority of CPO-colonized patients (141/159, 89%) had blaKPC; 31 (5%) of patients identified at 6 vSNFs carried blaVIM. In a multivariable model, respiratory support (mechanical ventilation or tracheostomy collar) and ward type (ventilator ward) were independently associated with increased risk of CPO carriage (P<0.001, Table 2).

    Conclusion: Residents in vSNFs have a high risk for CPO carriage; the risk is highest among those cared for in the ventilator ward, and among those requiring respiratory support (mechanical ventilation or tracheostomy collar). While blaKPC is the most common carbapenemase gene found in the Chicago region, other carbapenemases such as blaVIM may be emerging. When regional public health CPO control efforts target high risk facilities, vSNFs must be included.

     

    Michael Y. Lin, MD, MPH1, Mary Carl Froilan, RN2, Karen Lolans, BS1, Pamela Bell, BS2, David Wirth, MPH2, Sarah K. Kemble, MD3, Massimo Pacilli, MS MPH3, Stephanie R. Black, MD, MSc3, Olufemi Jegede, MPH4, Erica Runningdeer, MSN, MPH, RN5, Angela S. Tang, MPH5, Chinyere Alu, MPH5, Rachel Slayton, PhD, MPH6, Anthony E. Fiore, MD6, John A. Jernigan, MD, MS6, William E. Trick, MD2,7, Robert A. Weinstein, MD2, Mary K. Hayden, MD8 and for the CDC Prevention Epicenter Program, (1)Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, (2)Rush University Medical Center, Chicago, IL, (3)Chicago Department of Public Health, Chicago, IL, (4)Cook County Department of Public Health, Oak Forest, IL, (5)Illinois Department of Public Health, Chicago, IL, (6)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (7)Cook County Health and Hospitals System, Chicago, IL, (8)Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, IL

    Disclosures:

    M. Y. Lin, OpGen, Inc.: Receipt of donated laboratory services , Research support
    Sage, Inc.: receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

    M. C. Froilan, None

    K. Lolans, None

    P. Bell, None

    D. Wirth, None

    S. K. Kemble, None

    M. Pacilli, None

    S. R. Black, None

    O. Jegede, None

    E. Runningdeer, None

    A. S. Tang, None

    C. Alu, None

    R. Slayton, None

    A. E. Fiore, None

    J. A. Jernigan, None

    W. E. Trick, None

    R. A. Weinstein, None

    M. K. Hayden, OpGen, Inc.: Receipt of donated laboratory services for project , Research support
    Clorox: Grant Investigator , Research support
    Molnlycke: Co-I on a different research project for which Molnlycke has contributed product , Conducting studies in healthcare facilities that are receiving contributed product
    Sage, Inc.: receipt of contributed product for this project , Conducting studies in healthcare facilities that are receiving contributed product

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.