355. Sensitivity of Different Anatomic Sites for Detection and Duration of Colonization with Carbapenemase-producing Enterobacteriaceae (CPE)
Session: Poster Abstract Session: HAI: MDRO-GNR/Emerging Resistant Bacterial Pathogens
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • ID Week Poster 2017 - CPE.pdf (1.8 MB)
  • Background: CPE are a growing threat worldwide. Screening to identify colonization is critical to control transmission in hospitals, but the sensitivity of screening of different anatomic sites to detect colonization remains uncertain. We describe the results of CPE screening by anatomic site in a study of duration of colonization in Toronto, Canada.

    Methods: The Toronto Invasive Bacterial Diseases Network conducts population-based surveillance of CPE in Toronto/Peel Region. Consenting participants enrolled in the duration of colonization study are screened at enrolment, then q3mo until 4 consecutive negative swabs are obtained. At each visit, a questionnaire is completed and swabs of groin, rectum and previously positive sites are obtained. Swabs are incubated in BHI broth then planted to MacConkey agar with cefpodoxime. CPE are detected by standard methodology with PCR confirmation.

    Results: Of 147 eligible patients colonized/infected with CPE, 119 are enrolled, and 465 swab sets have been collected from 99. Overall, 16% (69/434) groin, 21% (92/431) rectal, 27% (22/81) urine, and 17% (9/47) wound cultures yielded CPE. Positive CPE results were obtained in 126 swab sets; in 35 (25%) both rectal and groin yielded CPE, in 57 (45%) only rectal yielded CPE, in 34 (27%) only groin yielded CPE. In 8/22 (36%) culture sets with positive urine specimens CPE was identified only in the urine. Species yield differed by anatomic site, with Klebsiella pneumoniae being detected in 25 (42%) rectal and 34 (58%) groin swabs, and Escherichia coli being detected in 58 (67%) rectal and 29 (33%) groin swabs (p<0.05). Using rectal swabs only in follow up would have detected 17/21 (81%) patients followed with both groin/rectal swabs; among 35 urine/groin/rectal specimen sets with at least one swab yielding CPE, 20 (57%) yielded CPE from the rectal swab.

    Conclusion: Differences in pathogen detection, prevalence, and species suggest multi-site swabbing may be important in identifying CPE colonization. Consistency in the site of detection suggests testing of previously positive sites should not be ignored when assessing duration of colonization.

    Emily Borgundvaag, MSc1,2, Amna Faheem, MBBS, MPH1,2, Shumona Shafinaz, MD1,2, Irene Armstrong, MD, MSc3,4, Brenda Coleman, PhD1,2, Karen Green, MSc, RN1,2, Kithsiri Jayasinghe, MSc1,2, Jennie Johnstone, MD, PhD5, Kevin Katz, MD, CM, MSc, FRCPC6, Philipp Kohler, MD1,2, Allison Mcgeer, MD, MSc1,2,4, Roberto Melano, PhD4,7, Matthew Muller, MD, PhD8, Samir Patel, PhD4,7, Susan Poutanen, MD, MPH, FRCPC2,4, Anu Rebbapragada, PhD9, David Richardson, MD10, Alicia Sarabia, MD11, Andrew E. Simor, MD, FRCPC, FACP12, Barbara Willey, ART2 and Laura Wisely, RT1,2, (1)Toronto Invasive Bacterial Diseases Network, Toronto, ON, Canada, (2)Mount Sinai Hospital, Toronto, ON, Canada, (3)Toronto Public Health, Toronto, ON, Canada, (4)University of Toronto, Toronto, ON, Canada, (5)St. Joseph's Health Centre, Toronto, ON, Canada, (6)North York General Hospital, Toronto, ON, Canada, (7)Public Health Ontario Laboratories, Toronto, ON, Canada, (8)St. Michael's Hospital, Toronto, ON, Canada, (9)Gamma Dynacare, Toronto, ON, Canada, (10)William Osler Health System, Brampton, ON, Canada, (11)Credit Valley Hospital, Mississauga, ON, Canada, (12)Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Disclosures:

    E. Borgundvaag, None

    A. Faheem, None

    S. Shafinaz, None

    I. Armstrong, None

    B. Coleman, None

    K. Green, None

    K. Jayasinghe, None

    J. Johnstone, None

    K. Katz, None

    P. Kohler, None

    A. Mcgeer, None

    R. Melano, None

    M. Muller, None

    S. Patel, None

    S. Poutanen, None

    A. Rebbapragada, None

    D. Richardson, None

    A. Sarabia, None

    A. E. Simor, None

    B. Willey, None

    L. Wisely, 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.