1196. Serratia marcescens Strains Carrying blaKPC-2 and blaKPC-3 Carbapenemase Associated With Chronic Mechanical Ventilation
Session: Poster Abstract Session: Healthcare Epidemiology: MDR-Gram Negative Infections
Friday, October 5, 2018
Room: S Poster Hall
Background: Carbapenem resistance (CR) in enterobacteriaceae is a growing concern which the CDC has designated as an urgent threat. At our institution we have noted emergence of CR strains in clinical isolates including a growing number of Serratia marcescens. CR in Serratia marcescens in the US is mostly reported to be encoded by the SME family of chromosomally encoded carbapenemases, while in Asia it has been described being mediated by transmissible plasmids such as KPC. Here we describe the emergence and characteristics of CR Serratia marcescens at an academic tertiary care hospital in New York.

Methods: Serratia marcescens isolates demonstrating in vitro carbapenem resistance were recovered over a 12-month period from six distinct patients. Antibiotic resistance was determined by standard methods. Real-time PCR for bla(KPC), mcr gene, bla(NDM-1), bla(VIM), and bla(OXA-48) was performed. Patient comorbidities, source of culture, location in the hospital, and co-infection with other CR organisms were investigated.

Results: Fourteen Serratia marcescens isolates demonstrating in vitro carbapenem resistance were recovered from six individual patients. All six patients had a history of chronic respiratory failure with tracheostomy and at least partial ventilator dependence. Five of the patients were located on the pulmonary intermediate care unit, and one in the pediatric intensive care unit. Twelve of the 14 isolates were tracheal or sputum cultures. Five of the sputum cultures from two patients were co-infected with CR Pseudomonas, and one sputum culture was simultaneously positive for CR Klebsiella pneumoniae and Enterobacter Cloacae. Nine out of 14 isolates were positive for blaKPC-3, two were blaKPC-2 positive, and three were blaKPC-negative, with no mechanism of carbapenem resistance determined yet. None of the other genes were detected.

Conclusion: Most carbapenem resistant Serratia isolates were derived from respiratory tract and were found to be positive for blaKPC-3. This suggests that plasmid encoded carbapenemases are emerging among Serratia in the US, which is already being reported in China. Genomic sequencing may establish whether this represents a clonal expansion and whether the blaKPC plasmid was transferred from Klebsiella or Enterobacter to Serratia in one of the patients.

Matthew Fisher, M.D.1, Elizabeth Diago-Navarro, PhD2, Olga Kaplun, MD1, Eric Sin, MD3 and Bettina C. Fries, MD, FIDSA4, (1)Infectious Diseases, STONY BROOK UNIVERSITY HOSPITAL, STONY BROOK, NY, (2)Department of Medicine (Division of Infectious Disease), Stony Brook University Hospital, Stony Brook, NY, (3)Infectious Disease, Stony Brook University Hospital, Stony Brook, NY, (4)Stony Brook University, Stony Brook, NY

Disclosures:

M. Fisher, None

E. Diago-Navarro, None

O. Kaplun, None

E. Sin, None

B. C. Fries, None

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