1178. A multicenter prospective study of clinical and molecular epidemiological analysis of carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing Enterobacteriaceae (CPE) in Japan
Session: Poster Abstract Session: Healthcare Epidemiology: MDR-Gram Negative Infections
Friday, October 5, 2018
Room: S Poster Hall

Background: Data of a multicenter study on CRE from Japan are limited. Comparative analyses of carbapenemase-producing Enterobacteriaceae (CPE) and non-carbapenemase-producing CRE (NCP-CRE) have not yet been conducted.

Methods: Cases with CPE or CRE (defined as: (1) meropenem [MPM] MIC, ≥2 mg/L or (2) imipenem [IPM] MIC, ≥2 mg/L and cefmetazole MIC, ≥64 mg/L [CLSI criteria]) were included from 08/2016 to 05/2017. PCR was used to detect carbapenemase.

Results: From 5 tertiary hospitals, 24 isolates (14 CPE and 10 NCP-CRE) were collected from 22 patients. Of the 10 NCP-CRE, 7 were Enterobacter aerogenes and 3 were Enterobacter cloacae; of the 14 CPE, 5 were Klebsiella pneumoniae; 3, E. cloacae; 3, E. coli; 2, Citrobacter freundii; and 1, E. aerogenes. CPE were frequently isolated from the urine (5 [42%]) and sputum (3 [25%]) and NCP-CRE from sputum (4 [40%]), bile (3 [30%]), and urine (2 [20%]). Cases with CPE were older with more frequent use of urinary catheter and/or NG tube than NCP-CRE (Table). The 30-day mortality or length of hospital stay (LOS) did not differ between the 2 groups. Majority (n = 12) of CPE were identified to carry blaIMP (MPM MIC, ≥2 mg/L), and 2 CPE were positive for blaOXA-181 and blaOXA-232 (MPM MIC, ≤1 mg/L). All NCP-CRE had IPM MIC of ≥2 mg/L; 7 (70%) had MPM of ≤1 mg/L. Resistance to amikacin (AMK) and levofloxacin (LFX) was noted in 1 and 5 CPE, respectively, whereas all NCP-CRE were sensitive, and 9 blaIMP and 1 blaoxa-232 were transferable by conjugation.

Conclusion: CPE and NCP-CRE had different clinical characteristics. Non-beta-lactam treatment options were more available for NCP-CRE than CPE. CPE and NCP-CRE might require different control strategies.

Table. Comparison of CPE and NCP-CRE, n (%)

CPE (n = 12)

NCP-CRE (n = 10)

P

AgeA

80 (74-93)

68 (63-73)

0.04

Male

5 (42)

8 (80)

0.1

Nursing home residence

4 (33)

0

0.1

Charlson Comorbidity IndexA

3 (1-5)

2 (2-5)

0.92

Dependent functional status

9 (75)

3 (30)

0.08

Urinary catheter

9 (75)

2 (20)

0.03

NG tube

8 (67)

0

<0.01

Infection (not colonization)

3 (27)

3 (30)

>0.99

Polymicrobial isolation

7 (58)

9 (90)

0.16

Carbapenem exposureB

3 (25)

2 (20)

>0.99

Any antimicrobial exposureB

10 (83)

8 (80)

>0.99

30-day mortality

1 (10)

0

>0.99

LOS after isolationA, days

31 (10-59)

22 (8-45)

0.39

A Median (IQR), B 1 month

Kayoko Hayakawa, MD, PhD1, Hideaki Kato, MD2, Ryota Hase, MD3, Jumpei Hasumi, MD4, Takahito Nei, MD5, Ryuichi Nakano, PhD6, Hisakazu Yano, MD6, Maki Nagashima, M.T.1 and Norio Ohmagari, MD, MSc, PhD1, (1)Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan, (2)Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan, (3)Department of Infectious Diseases, Narita Red Cross Hospital, Narita, Chiba, Japan, (4)Department of Pediatrics, Saku Central Hospital Advanced Care Center, Saku, Japan, (5)Department of Infection Control and Prevention, Nippon Medical School Hospital, Tokyo, Japan, (6)Department of Microbiology and Infectious Diseases, Nara Medical University, Nara, Japan

Disclosures:

K. Hayakawa, None

H. Kato, None

R. Hase, None

J. Hasumi, None

T. Nei, None

R. Nakano, None

H. Yano, None

M. Nagashima, None

N. Ohmagari, None

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