371. National Prevalence and Regional Variation of Carbapenem-resistant Gram-negative Bacteria in the Ambulatory and Acute Care Settings in the United States in 2016
Session: Poster Abstract Session: HAI: MDRO-GNR/Emerging Resistant Bacterial Pathogens
Thursday, October 5, 2017
Room: Poster Hall CD
  • IDWeek 2017Poster 371 - final.pdf (3.1 MB)
  • Background: Infection caused by carbapenem resistant (CR) Gram-negative organisms is recognized as a major public health concern. This study estimated the national prevalence of CR events in the acute care and ambulatory settings based on a large electronic database (Becton, Dickinson and Company).

    Methods: Susceptibility data from non-duplicate cultures of fermenting Gram-negatives (E. coli, K. pneumoniae, P. mirabilis, E. aerogenes, E. cloacae, S. marcescens, C. freundii, M. morganii) and non-fermenting Gram-negatives (P. aeruginosa, A. baumannii, A. baumannii/haemolyticus, S. maltophilia) from all sources were identified from 354 hospitals nationwide for calendar year 2016. CR fermenters were defined as intermediate or resistant to imipenem, meropenem or ertapenem. CR P. aeruginosa, A. baumannii, and A. baumannii/haemolyticus were defined as intermediate or resistant to imipenem or meropenem. All non-duplicate S. maltophilia were considered CR.

    Ambulatory, admission, and hospital-onset periods were defined based on culture collection time. National prevalence was estimated using raking weighting method per CMS national hospital distribution by location, teaching status, urban/rural status, and bed size. Regional variation for inpatient CR rates per 100 admissions was evaluated for 388 hospitals in Q4 2016.

    Results: Of 652,346 isolates tested from 1 January to 31 December 2016, 28,569 (4.4%) were CR and the total annual projected CR events is 287,910. The annual CR rates were 11.6% during the hospital onset period, 6.1% at admission and 2.5% for ambulatory. Approximately 71% (205,490) of all CR events were from non-fermenters.

    Among 3781 CR cases from 388 facilities in Q4 2016, 2903 (77%) were non-fermenters: 1483 (39%) P. aeruginosa, 1084 (29%) S. maltophilia, 234 (6%) A. baumannii and 102 (3%) A. baumannii/haemolyticus. Among 294 CR fermenters: 8% were K. pneumoniae and 2% were E. coli. CR rates varied geographically from <0.03 to >=1.28 per 100 admissions during the same quarter.

    Conclusion: Hospital onset CR rates were much higher than admission or ambulatory onset. Non-fermenters, especially P. aeruginosa and S. maltophilia, contributed a much larger proportion of CR cases. The CR rates varied from region to region.

    Bin Cai, MD, PhD1, Roger Echols, MD, FIDSA2, Gareth Morgan, Ph.D3, David Van Veenhuyzen, MBChB, MPharmMed3, Mari Ariyasu, Ph.D4, Takuko Sawada, BA4, John Murray, MPH5, Tsutae Den Nagata, MD, PhD, FFPM4 and Vikas Gupta, PharmD, BCPS5, (1)Shionogi Inc., Florham Park, NJ, (2)ID3C, Easton, CT, (3)SHIONOGI INC., Florham Park, NJ, (4)SHIONOGI & CO., LTD., Osaka, Japan, (5)Becton, Dickinson and Company, Franklin Lakes, NJ


    B. Cai, Shionogi Inc: Employee , Salary

    R. Echols, Shionogi & CO., LTD: Consultant , Consulting fee

    G. Morgan, Shionogi Inc: Employee , Salary

    D. Van Veenhuyzen, Shionogi Inc: Employee , Salary

    M. Ariyasu, Shionogi: Employee , Salary

    T. Sawada, Shinogi: Employee , Salary

    J. Murray, None

    T. D. Nagata, Shionogi: Employee , Salary

    V. Gupta, None

    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.