1194. Carbapenem-Resistant Enterobacteriaceae in Kentucky - Initial Six Months of Mechanism Testing
Session: Poster Abstract Session: Healthcare Epidemiology: MDR-Gram Negative Infections
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • IDWeek_poster-1194_Spicer.pdf (555.6 kB)
  • Background: A global rise in carbapenem-resistant Enterobacteriaceae (CRE) has been noted over the past two decades. State and local data on CRE are necessary to better inform public health interventions.

    Methods: Reporting of CRE (i.e., Enterobacteriaceae resistant to any carbapenem or shown to produce a carbapenemase) was mandated in Kentucky in 2015. Voluntary submission of isolates to the Antibiotic Resistance Laboratory Network regional laboratory for carbapenemase testing began September 2017. Demographic data collected as part of reporting included age, sex, county of residence, and inpatient/outpatient status. Descriptive and chi-square analyses were performed.

    Results: Between 9/1/2017 and 2/28/2018, 149 CRE were reported to the Kentucky Department for Public Health. Testing for presence of a carbapenemase was performed on 115 isolates (77.2%); 44 (38.3%) were carbapenemase producing (CP)-CRE and Klebsiella pneumoniae carbapenemase (KPC) was identified from 38 (86.4%). Also identified were Verona integron-encoded metallo-β-lactamase (VIM; 5, 11.4%) and New Delhi metallo-β-lactamase (NDM; 1, 2.3%). Identification of carbapenemase varied among genera: Citrobacter (3/4, 75%), Klebsiella (21/40, 52.5%), Serratia (2/5, 40%), Escherichia (6/20, 30%), Enterobacter (11/41, 26.8%), Proteus (0/4, 0%), other genera (1/2, 50%). CRE isolates from urban or suburban areas were more likely CP-CRE than were those from rural areas (30/65, 46.2% versus 14/50, 28%, p = 0.047). Carbapenemase was identified more often among CRE isolates from currently hospitalized patients than from patients whose cultures were collected outside of an acute care hospital (37/70, 52.8% versus 7/45, 15.6%; p < 0.001).

    Conclusion: The percentage of CRE that were CP-CRE in Kentucky was comparable to that reported for the United States (38 versus 32%). Klebsiella spp., the genera historically associated with CP-CRE, made up less than half of CP-CRE. CP isolates were identified from urban, suburban, and rural settings and more frequently from isolates collected in hospitals compared to the community. The additional epidemiology obtained as part of this reporting system has identified metropolitan areas of the state as targets for CRE prevention efforts.

    Kevin Spicer, MD, PhD, MPH1, Katelyn Cox, BS2, Rachel Zinner, MS2 and Andrea Flinchum, MPH, BSN, CIC3, (1)Prevention and Response Branch, Centers for Disease Control & Prevention, Division of Healthcare Quality Promotion, Frankfort, KY, (2)Microbiology, Division of Laboratory Services, Kentucky Department for Public Health, Frankfort, KY, (3)Epidemiology, Healthcare-Associated Infection Prevention Program, Kentucky Department for Public Health, Frankfort, KY

    Disclosures:

    K. Spicer, None

    K. Cox, None

    R. Zinner, None

    A. Flinchum, None

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