1162. Epidemiology of Carbapenem-Resistant Pseudomonas aeruginosa Identified through the Emerging Infections Program (EIP), United States, 2016–2017
Session: Poster Abstract Session: Healthcare Epidemiology: MDR-Gram Negative Infections
Friday, October 5, 2018
Room: S Poster Hall
Background: Pseudomonas aeruginosa is intrinsically resistant to many commonly used antimicrobials and carbapenems are often required to treat infections. We describe the epidemiology and crude incidence of carbapenem-resistant P. aeruginosa (CRPA) in the EIP catchment area.

Methods: From August 1, 2016 through July 31, 2017, we conducted laboratory- and population-based surveillance for CRPA in selected metropolitan areas in Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon and Tennessee. We defined an incident case as the first isolate of P. aeruginosa resistant to imipenem, meropenem, or doripenem from the lower respiratory tract, urine, wounds, or normally sterile sites identified from a resident of the EIP catchment area in a 30-day period. Patient charts were reviewed. A random sample of isolates was screened at CDC for carbapenemases using the modified carbapenem inactivation method (mCIM) and real-time PCR.

Results: During the 12-month period, we identified 3042 incident cases among 2154 patients. The crude incidence rate was 21.2 (95% CI, 20.4–21.9) per 100,000 persons and varied by site (range: 7.7 in Oregon to 31.1 in Maryland). The median age of patients was 64 years (range: <1–101) and 41.2% were female. Nearly all (97.1%) had at least one underlying condition and 10.2% had cystic fibrosis (CF); 17.8% of cases were from CF patients. For most cases, isolates were from the lower respiratory tract (49.2%) or urine (35.3%) and occurred in patients with recent hospitalization (87.2%) or indwelling devices (70.3%); 8.7% died. At the clinical laboratory, 84.7% of isolates were susceptible to an aminoglycoside and 66.4% to ceftazidime or cefepime. Among the 391 isolates tested, 9 (2.3%) were mCIM-positive; one had a carbapenemase detected by PCR (blaVIM-4).

Conclusion: The burden of CRPA varied by EIP site. Most cases occurred in persons with healthcare exposures and underlying conditions. The majority of isolates were susceptible to at least one first-line antimicrobial. Carbapenemase-producers were rare; a more specific phenotypic definition would greatly facilitate surveillance for these isolates.

Julian Grass, MPH1, Sandra Bulens, MPH1, Wendy Bamberg, MD2, Sarah J. Janelle, MPH, CIC2, Patrick Stendel, MPH2, Jesse T. Jacob, MD3,4, Chris Bower, MPH4,5,6, Stephen Sukumaran, MPH4,5,6, Lucy E. Wilson, MD, ScM7, Elisabeth Vaeth, MPH8, Linda Li, MPH7, Ruth Lynfield, MD, FIDSA9, Paula Snippes Vagnone, MT (ASCP)9, Ginette Dobbins, BS9, Erin C. Phipps, DVM, MPH10, Emily B. Hancock, MS10, Ghinwa Dumyati, MD, FSHEA11, Rebecca Tsay, MPH, MLS11, Rebecca Pierce, PhD, MS, BSN12, P. Maureen Cassidy, MPH13, Nicole West, MPH13, Marion A. Kainer, MBBS, MPH14, Daniel Muleta, MD, MPH14, Jacquelyn Mounsey, BSN, RN, CCRP14, Davina Campbell, MPH1, Richard Stanton, PhD1, Maria S. Karlsson, PhD1 and Maroya Spalding Walters, PhD, ScM15, (1)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (2)Colorado Department of Public Health and Environment, Denver, CO, (3)Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, (4)Georgia Emerging Infections Program, Decatur, GA, (5)Atlanta Veterans Affairs Medical Center, Decatur, GA, (6)Atlanta Research and Education Foundation, Decatur, GA, (7)Maryland Department of Health, Baltimore, MD, (8)Infectious Disease Epidemiology and Outbreak Response Bureau, Maryland Department of Health, Baltimore, MD, (9)Minnesota Department of Health, St. Paul, MN, (10)New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, NM, (11)NY Emerging Infections Program, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, NY, (12)Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, OR, (13)Oregon Health Authority, Portland, OR, (14)Tennessee Department of Health, Nashville, TN, (15)Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

J. Grass, None

S. Bulens, None

W. Bamberg, None

S. J. Janelle, None

P. Stendel, None

J. T. Jacob, None

C. Bower, None

S. Sukumaran, None

L. E. Wilson, None

E. Vaeth, None

L. Li, None

R. Lynfield, None

P. S. Vagnone, None

G. Dobbins, None

E. C. Phipps, None

E. B. Hancock, None

G. Dumyati, None

R. Tsay, None

R. Pierce, None

P. M. Cassidy, None

N. West, None

M. A. Kainer, None

D. Muleta, None

J. Mounsey, None

D. Campbell, None

R. Stanton, None

M. S. Karlsson, None

M. Spalding Walters, None

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