2165. Risk Factors for CPE Colonization in Household Contacts of CPE Colonized/Infected Patients.
Session: Poster Abstract Session: Healthcare Epidemiology: HAI Surveillance
Saturday, October 6, 2018
Room: S Poster Hall
Background: Carbapenemase-producing Enterobacteriaceae (CPE) are a global threat. Risk of transmission of CPE in households remains poorly understood

Methods: Population based surveillance for CPE colonization/infection is conducted in Toronto/Peel Region, Canada. In households with ≥1 consenting household contact (HC), groin, rectal swabs and urine samples are submitted every 3 months for both IC and HC until the IC has 3 consecutive negative swab sets. Swabs/urines are incubated overnight in BHI, direct PCR for carbapenemase genes is performed; specimens positive for PCR are then cultured.

Results: 85 households and 150 HC have been enrolled. Most common species/gene combinations in IC are: E.coli/NDM (33), E.coli/OXA48 (15), Klebsiella spp./NDM (11). HCs have a median of 8 swabs (range 2-14). 12 (8%) HCs were colonized with CPE (median 1.5 pos samples, range 1-8). IC and HC had same gene in 11(92%) cases, and same species/gene in 7 (58%) cases. NDM+OXA48 ICs were more likely to have CPE colonized HC, see Table. CPE colonized HC were older, more likely to be the IC’s spouse (OR 32, 95% CI 4-260), and more likely to have travelled outside Canada (OR 9.7, 95%CI 1.2-78).

Conclusion: HC colonization with CPE is uncommon,but not rare, and may be associated with either household transmission, or co-exposure of HC and IC via travel. Spouses are most often colonized.

Characteristic

CPE positive

N=12

CPE negative

N=138

P value

Gender (n, % male)

3 (25%)

53 (38%)

.27

Median age (range)

70y(24-89)

42y (4-98)

.005

Chronic illness

6 (50%)

35 (25%)

.08

Relationship to IC

Spouse

Child

Other

11(92%)

1 (8%)

0

35 (25%)

41 (30%)

62 (45%)

<.0001

Hospitalization (last yr)

Outside Canada

In Canada

0

0

2 (2%)

12 (9%)

.84

.35

Travel outside Canada (last yr)

to Indian subcontinent

11 (92%)

8 (67%)

73 (54%)

47 (35%)

0.01

0.03

Receipt antibiotics (6 mos)

1 (8%)

10 (7%)

.61

Contact with IC

Regular skin-skin contact

Share washroom

Share towels

5 (42%)

11 (92%)

7 (58%)

68 (50%)

97 (72%)

61 (47%)

.76

.18

.37

IC organism

E. coli

Klebsiella spp.

6/12(50%)

4 (33%)

46/73 (63%)

18 (25%)

.59

IC gene

NDM

OXA-48

NDM and OXA-48

KPC

Other

3 (25%)

4 (33%)

5 (42%)

0

0

43 (59%)

18 (24%)

2 (3%)

7 (10%)

3 (4%)

<.001

IC colonization

>3 mo

>6 mo

7/11(64%)

6/10(60%)

32/61(52%)

23/53(43%)

.72

.49

Lubna Farooqi, MBBS1, Amna Faheem, MBBS, MPH2, Irene Armstrong, MD3, Emily Borgundvaag, MSc4, Brenda Coleman, PhD5, Karen Green, MSc, RN6, Kithsiri Jayasinghe, MSc6, Jennie Johnstone, MD, PhD7, Kevin Katz, MD, CM, MSc, FRCPC8, Philipp Kohler, MD4, Angel Li, MSc6, Roberto Melano, PhD9, Matthew Muller, MD, FRCPC, PhD10, Sarah Nayani, PhD11, Samir Patel, PhD12, Aimee Paterson, MSc6, Susan Poutanen, MD, MPH6, Anu Rebbapragada, PhD13, David Richardson, MD14, Alicia Sarabia, MD15, Shumona Shafinaz, MD6, Andrew E. Simor, MD, FRCPC, FACP16, Barbara Willey, ART17, Laura Wisely, RT6, Zoe Zhong, PhD1 and Allison McGeer, MD, MSc18, (1)Sinai Health System, Toronto, ON, Canada, (2)Infection Control, Mount Sinai Hospital, Toronto, ON, Canada, (3)Toronto Public Health, Toronto, ON, Canada, (4)Toronto Invasive Bacterial Diseases Network, Toronto, ON, Canada, (5)Microbiology, Mount Sinai Hospital, Toronto, ON, Canada, (6)Mount Sinai Hospital, Toronto, ON, Canada, (7)Public Health Ontario, Toronto, ON, Canada, (8)Department of Infection Control, North York General Hospital, Toronto, ON, Canada, (9)Public Health Ontario Laboratory, Toronto, ON, Canada, (10)Infectious Diseases, St Michael's Hospital, Toronto, ON, Canada, (11)Microbiology, Sinai Health System, Toronto, ON, Canada, (12)University of Toronto, Toronto, ON, Canada, (13)Gamma Dynacare, Toronto, Toronto, ON, Canada, (14)William Osler Health System, Brampton, ON, Canada, (15)Trillium Health Partners, Mississauga, ON, Canada, (16)Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, (17)University Health Network, Toronto, ON, Canada, (18)Infection Control, University of Toronto, Toronto, ON, Canada

Disclosures:

L. Farooqi, None

A. Faheem, None

I. Armstrong, None

E. Borgundvaag, None

B. Coleman, None

K. Green, None

K. Jayasinghe, None

J. Johnstone, None

K. Katz, None

P. Kohler, None

A. Li, None

R. Melano, None

M. Muller, None

S. Nayani, None

S. Patel, None

A. Paterson, None

S. Poutanen, MERCK: Scientific Advisor , Speaker honorarium . COPAN: Speaker(but not part of a bureau) , Travel reimbursement . Accelerate Diagnostics: Investigator , Research support . Bio-Rad: Investigator , Research support . bioMérieux: Investigator , Research support .

A. Rebbapragada, None

D. Richardson, None

A. Sarabia, None

S. Shafinaz, None

A. E. Simor, None

B. Willey, None

L. Wisely, None

Z. Zhong, None

A. McGeer, None

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