1186. Prevalence of Carbapenemase-Producing Enterobacteriaceae (CPE) in Hospital Drains in Southern Ontario
Session: Poster Abstract Session: Healthcare Epidemiology: MDR-Gram Negative Infections
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • IDWeek Poster Alainna.pdf (372.6 kB)
  • Background: Hospital waste water systems are an emerging reservoir for CPE. We aimed to describe the prevalence of CPE in hospital drains in southern Ontario, where patients are rarely colonized/infected by CPE.

    Methods: 10 Ontario hospitals identified rooms occupied by CPE+ inpatients from 2007-17. Drain swabs from patient rooms and communal shower rooms were inoculated into BHI + 10% Dey-Engley neutralizing broth and incubated overnight, then PCR on enriched broth for carbapenemase genes as well as culture on McPOD/McMEM were performed.

    Results: Over 10 yrs in 10 hospitals, 343 CPE+ inpatients exposed 1205 drains (852 sinks, 353 bathtub/shower drains) in 501 patient rooms and 71 communal shower rooms. 53 (4%) drains in 40 (8%) patient rooms and 10 (14%) communal shower rooms were CPE+ by PCR and culture. CPE+ drains were from 15/475 (3%) hand hygiene sinks, 4/352 (1%) bathroom sinks, 23/272 (9%) bathtubs/showers, and 11/81 (13.6%) communal showers. 11 (21%) of the CPE+ drains contained ³1 CPE gene/species combinations. Patient room drain CPE gene/species combinations are shown in Figure 1: 8 (15%) matched the CPE gene/species combination of a room occupant, 23 (43%) matched gene only, and 23 (43%) did not match. 54% of drain isolates were Enterobacter spp. but 9% of patient isolates were Enterobacter spp. There were 155 (13%) additional drains with one or more genes detected by PCR but not culture; 94 (61%) contained VIM (88 bathtub, 1 bathroom sink, and 5 hand hygiene sink drains), 33 GES, 17 OXA, 16 IMP, 10 KPC, and 5 NDM. There were 6 drains where one or more genes were detected by culture but not PCR; 4 (67%) were bathtub/shower drains containing an OXA, 1 bathtub/shower drain containing a NDM, and 1 hand hygiene sink drain containing a KPC.

    Conclusion: Hospital drains may become a reservoir for CPE, which may persist for years. Sensitivity of PCR and culture for detection of CPE and CP organisms may differ. The presence of  ÒunmatchedÓ drains suggests undetected patient colonization. Risk of transmission from drains to room occupants requires investigation.   

    Figure 1. Patient room CPE drain isolate gene/species combinations (N=54).

    Alainna Jamal, Hons. BSc1, Mahin Baqi, MD2, Sergio Borgia, MD3, William Cicotelli, MD4, Kornelija Delibasic, ICP5, Kevin Katz, MD, CM, MSc, FRCPC6, Jennie Johnstone, MD, PhD7, Roberto Melano, PhD8, Matthew Muller, MD, FRCPC, PhD9, Sharon O'Grady, ICP10, Samir Patel, PhD11, David Richardson, MD12, Aimee Paterson, MSc13, Angel Li, MSc13 and Allison McGeer, MD, MSc14, (1)Medicine, University of Toronto, Toronto, ON, Canada, (2)WIlliam Osler Health System, Etobicoke, ON, Canada, (3)William Osler Health System, Brampton Civic Hospital, Brampton, ON, Canada, (4)Grand River Hospital, Kitchener, ON, Canada, (5)Markham Stouffville Hospital, Markham, ON, Canada, (6)Department of Infection Control, North York General Hospital, Toronto, ON, Canada, (7)Public Health Ontario, Toronto, ON, Canada, (8)Public Health Ontario Laboratory, Toronto, ON, Canada, (9)Infectious Diseases, St Michael's Hospital, Toronto, ON, Canada, (10)Sinai Health System, Toronto, ON, Canada, (11)University of Toronto, Toronto, ON, Canada, (12)William Osler Health System, Brampton, ON, Canada, (13)Mount Sinai Hospital, Toronto, ON, Canada, (14)Infection Control, University of Toronto, Toronto, ON, Canada

    Disclosures:

    A. Jamal, None

    M. Baqi, None

    S. Borgia, None

    W. Cicotelli, None

    K. Delibasic, None

    K. Katz, None

    J. Johnstone, None

    R. Melano, None

    M. Muller, None

    S. O'Grady, None

    S. Patel, None

    D. Richardson, None

    A. Paterson, None

    A. Li, None

    A. McGeer, None

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