352. Investigation of Epidemiology and Pathogenesis of Co-infection with Multiple Carbapenem-Resistant Enterobactereciae in Hospitalized Patients
Session: Poster Abstract Session: HAI: MDRO-GNR/Emerging Resistant Bacterial Pathogens
Thursday, October 5, 2017
Room: Poster Hall CD
Background: Carbapenem-resistant Enterobactereciae (CRE) are an emerging cause of major morbidity and mortality in hospitalized patients. These organisms are difficult to treat due to antibiotic resistance conferred by plasmid-derived genes, most commonly blaKPC-2 and blaKPC-3. In this study, patients infected with multiple distinct CRE species were investigated in order to better understand the epidemiology and pathogenesis of CRE co-infection.

Methods: A retrospective study was undertaken using data from the CRaCKLe 2 study at Stony Brook University Hospital between July 2016 and April 2017. Medical records of patients infected with multiple CRE species were reviewed and isolated organisms were screened for blaKPC using PCR.

Results: Of the first 75 patients enrolled in the CRaCKLe 2 study, 8 (10.7%) were found to harbor two distinct species of CRE. The mean age was 71.8 (SD of ± 7.1) years. Seven (87.5%) had been previously hospitalized within the last year, and all spent time in an ICU during this hospital stay. Two patients were colonized with CRE by the time of hospitalization; however the remainder had received an average of 5.2 (± 2.1) different antibiotics over a course of 22.9 (± 9.1) days of treatment prior to the isolation of a CRE. Bacteria were acquired from urine (7 isolates), the respiratory tract (7 isolates), and from abdominal fluid (2 isolates), with both organisms found in a single site in 5 patients, and from separate sites in the remaining 3 patients. PCR of isolates identified blaKPC genes in both organisms in 6 patients, however 2 of the patients harbored one organism with a blaKPC gene and one without.

Conclusion: Hospitalized patients may develop multiple distinct CRE at the same or different sites, with potential risk factors including age, prior hospitalization, ICU stay, and exposure to multiple antibiotics over a prolonged course. Our data support co-infection occurring via (i) increased nosocomial exposure to CRE in the setting of repeated hospitalization and ICU admission, (ii) independent selective pressure due to heavy antibiotic exposure, as supported by the appearance of blaKPC and non- blaKPC species in the same host, or (iii) transfer of blaKPC-containing plasmids in the host environment, as suggested by the appearance of resistant species in those already infected with another CRE.

Thomas Holowka, PhD1, Melinda Monteforte, PharmD2, Roderick Go, DO3, Bennadette Maramara, MD4, Teresa Khoo, MD4, Robert Chow, MD5, Yasin Abul, MD5, Rahul Mahapatra, DO6, Alexa Morgan, .7, Elizabeth Diago-Navarro, PhD8 and Bettina C. Fries, MD, FIDSA9, (1)Stony Brook University School of Medicine, Stony Brook, NY, (2)Pharmacy Department, Stony Brook University Hospital, Stony Brook, NY, (3)SUNY Stony Brook, Lake Grove, NY, (4)Infectious Disease, Stony Brook University Hospital, Stony Brook, NY, (5)Infectious Diseases, Stony Brook University Hospital, Stony Brook, NY, (6)Infectious Diseases, STONY BROOK UNIVERSITY HOSPITAL, STONY BROOK, NY, (7)Stony Brook University Hospital, Stony Brook, NY, (8)Department of Medicine (Division of Infectious Disease), Stony Brook University Hospital, Stony Brook, NY, (9)Stony Brook University, Stony Brook, NY

Disclosures:

T. Holowka, None

M. Monteforte, None

R. Go, None

B. Maramara, None

T. Khoo, None

R. Chow, None

Y. Abul, None

R. Mahapatra, None

A. Morgan, None

E. Diago-Navarro, None

B. C. Fries, None

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