416. High Prevalence of Multidrug Resistant Organisms: MRSA, VRE, CRE, ESBLs and C. difficile at a Chicago LTACH
Session: Poster Abstract Session: HAI Non-Acute Care
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • ID Week 2017 LTCF Final 9-28-17 for upload.pdf (454.4 kB)
  • Background:Multidrug resistant organisms (MDROs) have been described in Chicago with long-term acute care hospitals (LTACHs) considered as the sites of amplification of these organisms. Accurate identification of colonized patients is an important strategy for decreasing the spread of MDROs.

    Methods:We conducted a point-prevalence study of Carbapenem resistant Enterobacteriaceae (CRE), Extended spectrum B-lactamases (ESBL), Vancomycin resistant Enterococci (VRE), Methicillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile (Cdif) carriage among patients in a Chicago LTACH in April 2017. Rectal specimens were collected using 1 double headed rayon swab (Copan) and 1 FecalSwab (Copan). Anterior nasal swabs were collected using a separate swab. ESBL and CRE cultures were performed using CHROMagar ESBL media (Hardy). ESBL phenotypic confirmation was done using double-disc synergy method per CLSI guidelines. In addition, direct CRE PCR was performed using the Xpert® Carba-R assay and an in-house PCR for blaKPC/NDM. VRE and MRSA culture was done using CNA agar (BD) and ChromMRSA agar (BBL). Bacterial identification and susceptibility was performed using MALDI-TOF and disc diffusion. Cdif PCR was performed using Xpert C. difficile/Epi assay.

    Results:81 patients were eligible for the study; 6 declined. Data was analyzed for 75 patients. Mean age of patients was 59 years (range: 24-90) and 45/75 (60%) patients were male. 54/75 (72%) patients had at least 1 MDRO. 18/75 (24%) patients had CRE rectal colonization; 17 blaKPC PCR positive and 1 positive for blaKPC/NDM/VIM. The CREs in 16/18 (89%) patients were K. pneumoniae; 1 E. cloacae, 1 M. morganii and 1 with both K. pneumoniae and E. aerogenes. Overall, 11/18 (61%) of CRE positive patients were also co-colonized with another MDRO. 17/75 (23%) patients had ESBLs, 13 /75 (17%) had MRSA, 31/75 (41%) had VRE and 6/75 (8%) had Cdif colonization.

    Conclusion:We found a high rate of MDRO colonization among patients in this Chicago LTACH. Comprehensive MDRO surveillance among LTACH patients is required to limit spread of significant pathogens.

    Ruby Barza, MT(ASCP)1, Kodi Wyant, M.D.1, Parul Patel, BS MT(ASCP), CCRP1, Jignesh Patel, PhD1, Katherine Mendoza, B.A1, Kathy Mangold, PhD1, Natali Chavez, BS MLS(ASCP)1, Kihe Kim, RN2, David Hines Jr., MD3 and Kamaljit Singh, MD4, (1)NorthShore University HealthSystem, Evanston, IL, (2)Kindred Hospital Chicago North, Chicago, IL, (3)Infectious Diseases, Metro Infectious Disease Consultants, Burr Ridge, IL, (4)Department of Pathology, NorthShore University HealthSystem, Evanston, IL

    Disclosures:

    R. Barza, None

    K. Wyant, None

    P. Patel, None

    J. Patel, None

    K. Mendoza, None

    K. Mangold, None

    N. Chavez, None

    K. Kim, None

    D. Hines Jr., None

    K. Singh, None

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