471. Molecular Characterization of Carbapenem-Resistant Enterobacteriaceae in the United States, 2011-2015
Session: Poster Abstract Session: HAI: Surveillance + Reporting
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • IDWeekPoster_Ansari_Final1.pdf (598.5 kB)
  • Background: Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as an important cause of healthcare-associated infections. We characterized the molecular epidemiology of CRE in isolates collected through the Emerging Infections Program (EIP) at the Centers for Disease Control and Prevention (CDC).

    Methods: From 2011-2015, 8 U.S. EIP sites (CO, GA, MD, MN, NY, NM, TN and OR) collected CRE (Escherichia coli, Enterobacter aerogenes, Enterobacter cloacae complex, Klebsiella pneumoniae, and Klebsiella oxytoca) isolated from a normally sterile site or urine. Isolates were sent to CDC for reference antimicrobial susceptibility testing and real-time PCR detection of carbapenemase genes (blaKPC, blaNDM, blaOXA-48). Phenotypically confirmed CRE were analyzed by whole genome sequencing (WGS) using an Illumina MiSeq benchtop sequencer.

    Results: Among 639 Enterobacteriaceae evaluated, 414 (65%) were phenotypically confirmed as CRE using CDC’s current surveillance definition (resistant to ertapenem, imipenem, doripenem, or meropenem). Among isolates confirmed as CRE, 303 (73%) were carbapenemase-producers (CP-CRE). The majority of CP-CRE originated from GA (39%), MD (35%) and MN (11%); most non-CP-CREs originated from MN (27%), CO (25%) and OR (17%). K. pneumoniae was the predominant carbapenemase-producing species (78%) followed by E. cloacae complex spp (12%), E. coli (7.9%), E. aerogenes (0.9%) and K. oxytoca (0.6%). The most common carbapenemase genes detected were blaKPC-3 (76%) and blaKPC-2 (19%); blaNDM and blaOXA-48-like genes were detected in 1.6% and 0.3% of isolates, respectively. For carbapenemase-producing K. pneumoniae, Enterobacter spp, and E. coli, the predominant sequence types (ST) were ST258 (65%), ST171 (35%) and ST131 (29%), respectively.

    Conclusion: The distribution of CP and non-CP-CRE varied across the catchment sites. Among CP-CRE, KPC-producing K. pneumoniae predominated; other carbapenemases were rarely identified in the locations under surveillance. Strain types known to have increased epidemic potential (ST258 and ST131) were common among carbapenemase-producing K. pneumoniae and E. coli isolates, respectively.

    Uzma Ansari, MS1, Adrian Lawsin, MS1, Davina Campbell, MPH1, Valerie Albrecht, MPH1, Gillian McAllister, BS1, Sandra Bulens, MPH1, Maroya Spalding Walters, PhD, ScM2, Jesse T. Jacob, MD3,4, Sarah W. Satola, PhD4,5, Lucy E. Wilson, MD, ScM6, Ruth Lynfield, MD, FIDSA7, Paula M Snippes Vagnone, MT (ASCP)8, Sarah J. Janelle, MPH, CIC9, Karen Xavier, MT(ASCP)9, Ghinwa Dumyati, MD, FSHEA10, Dwight Hardy, PhD10, Erin C. Phipps, DVM, MPH11, Karissa Culbreath, PhD12,13, Zintars Beldavs, MS14, Karim Morey, MS14, Marion A. Kainer, MBBS, MPH15, Sheri Roberts, MT16, Alexander Kallen, MD, MPH1, J. Kamile Rasheed, PhD1 and Maria S. Karlsson, PhD1, (1)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (2)Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, (3)Georgia Emerging Infections Program, Decatur, GA, (4)Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, (5)Georgia Emerging Infections Program, Atlanta, GA, (6)Maryland Department of Health, Baltimore, MD, (7)State Epidemiologist and Medical Director for Infectious Diseases, Epidemiology & Community Health, Minnesota Department of Health, St. Paul, MN, (8)Minnesota Department of Health, St. Paul, MN, (9)Colorado Department of Public Health and Environment, Denver, CO, (10)New York Emerging Infections Program at the University of Rochester Medical Center, Rochester, NY, (11)New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, NM, (12)TriCore Reference Laboratories, Albuquerque, NM, (13)University of New Mexico School of Medicine, Albuquerque, NM, (14)Oregon Health Authority, Portland, OR, (15)Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Public Health, Nashville, TN, (16)Tennessee Department of Public Health, Nashville, TN

    Disclosures:

    U. Ansari, None

    A. Lawsin, None

    D. Campbell, None

    V. Albrecht, None

    G. McAllister, None

    S. Bulens, None

    M. Spalding Walters, None

    J. T. Jacob, None

    S. W. Satola, None

    L. E. Wilson, None

    R. Lynfield, None

    P. M. Snippes Vagnone, None

    S. J. Janelle, None

    K. Xavier, None

    G. Dumyati, None

    D. Hardy, None

    E. C. Phipps, None

    K. Culbreath, None

    Z. Beldavs, None

    K. Morey, None

    M. A. Kainer, None

    S. Roberts, None

    A. Kallen, None

    J. K. Rasheed, None

    M. S. Karlsson, 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.