1205. Emergence of Carbapenemase Producing Enterobacteriaceae in South Central Ontario, Canada
Session: Poster Abstract Session: Healthcare Epidemiology: MDR-Gram Negative Infections
Friday, October 5, 2018
Room: S Poster Hall

Background: The spread of CPE is an increasing global threat to patient safety. We describe the introduction and evolution of CPE in south-central Ontario, Canada.

Methods: The Toronto Invasive Bacterial Diseases Network has performed population based surveillance for CPE in metropolitan Toronto and Peel region from first identified isolates in 2007. All laboratories test/refer all carbapenem non-susceptible Enterobacterial isolates for PCR testing for carbapenemases. Demographic and medical data and travel history are collected from chart review and patient/physician interview.

Results: Since 2007, 659 patients have been identified as colonized/infected with CPE; 362, 57%) have at least one clinical isolate. Annual incidence has increased from 0 in 2006 to 1.3 per 100,000 in 2016/17 (Fig 1). First bacteremia occurred in 2010, the incidence in 2017 was 0.14 per 100,000 population.  388 (59%) patients were male, median age was 70 years (range 3 mon-100 yrs).  Most common genes among 1st isolates were NDM (306, 46%), OX48 (149, 23%), KPC (122, 19%). Most common species were K. pneumoniae (268, 41%) and E. coli (259, 39%). Over time, second species/same gene were identified in 113 (16%) patients. In addition, 34/xxx patients with isolates with NDM and/or OXA-48 subsequently had a 2nd isolate with a different gene/gene combination. Of 518 patients whose travel and hospitalization history are available, patients with VIM were less likely than other patients to have a foreign hospitalization or travel history (9/28 vs. 341/490, P<.0001). Patients with KPC were more likely to have a hospitalization history outside Canada and the Indian subcontinent (25/70, 36%), in Canada (47/164,29%) than to have no hospitalization in the last year (13/93, 14%), or a history of hospitalization in the Indian subcontinent (2/191, 1%) (P<.001). The number of incident patients with different hospitalization and travel history over time is shown in Fig 2.

Conclusion: CPE is increasingly recognized in southern Ontario, both in patients with a history of exposure in healthcare in other countries, and to healthcare in Canada. Intensification of control programs is urgently needed.

Figure 1: Incidence of clinical isolates of CPE over time

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Figure 2:  Number of incident CPE cases with different hospitalization (H) and travel (T) history over time.

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Zoe Zhong, PhD1, Amna Faheem, MBBS, MPH2, Lubna Farooqi, MBBS1, Irene Armstrong, MD3, Emily Borgundvaag, MSc4, Brenda Coleman, PhD5, Karen Green, MSc, RN6, Kithsiri Jayasinghe, MSc6, Jennie Johnstone, MD, PhD7, Kevin Katz, MD, CM, MSc, FRCPC8, Philipp Kohler, MD4, Angel Li, MSc6, Roberto Melano, PhD9, Matthew Muller, MD, FRCPC, PhD10, Sarah Nayani, PhD11, Samir Patel, PhD12, Aimee Paterson, MSc6, Susan Poutanen, MD, MPH6, Anu Rebbapragada, PhD13, David Richardson, MD14, Alicia Sarabia, MD15, Shumona Shafinaz, MD6, Andrew E. Simor, MD, FRCPC, FACP16, Barbara Willey, ART17, Laura Wisely, RT6, Allison Mcgeer, MD, MSc18 and Toronton Invasive Bacterial Diseases Network, (1)Sinai Health System, Toronto, ON, Canada, (2)Infection Control, Mount Sinai Hospital, Toronto, ON, Canada, (3)Toronto Public Health, Toronto, ON, Canada, (4)Toronto Invasive Bacterial Diseases Network, Toronto, ON, Canada, (5)Microbiology, Mount Sinai Hospital, Toronto, ON, Canada, (6)Mount Sinai Hospital, Toronto, ON, Canada, (7)Public Health Ontario, Toronto, ON, Canada, (8)Department of Infection Control, North York General Hospital, Toronto, ON, Canada, (9)Public Health Ontario Laboratory, Toronto, ON, Canada, (10)Infectious Diseases, St Michael's Hospital, Toronto, ON, Canada, (11)Microbiology, Sinai Heatlh System, Toronto, ON, Canada, (12)University of Toronto, Toronto, ON, Canada, (13)Gamma Dynacare, Toronto, Toronto, ON, Canada, (14)William Osler Health System, Brampton, ON, Canada, (15)Trillium Health Partners, Mississauga, ON, Canada, (16)Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, (17)University Health Network, Toronto, ON, Canada, (18)Infection Control, Sinai Health System, Toronto, ON, Canada

Disclosures:

Z. Zhong, None

A. Faheem, None

L. Farooqi, None

I. Armstrong, None

E. Borgundvaag, None

B. Coleman, None

K. Green, None

K. Jayasinghe, None

J. Johnstone, None

K. Katz, None

P. Kohler, None

A. Li, None

R. Melano, None

M. Muller, None

S. Nayani, None

S. Patel, None

A. Paterson, None

S. Poutanen, MERCK: Scientific Advisor , Speaker honorarium . COPAN: Speaker(but not part of a bureau) , Travel reimbursement . Accelerate Diagnostics: Investigator , Research support . Bio-Rad: Investigator , Research support . bioMérieux: Investigator , Research support .

A. Rebbapragada, None

D. Richardson, None

A. Sarabia, None

S. Shafinaz, None

A. E. Simor, None

B. Willey, None

L. Wisely, None

A. Mcgeer, None

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