2064. Rapid detection of carbapenmase-producing Klebsiella pneumoniae (CPK) directly from respiratory secretion and clinical characteristics of patients with CPK from a 1200-bed tertiary care hospital in Thailand
Session: Poster Abstract Session: Diagnostics: Resistance Testing
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • PosterIDWEEK2018No2064.pdf (627.3 kB)
  • Background: There is an unmet need for rapid detection of carbapenemase-producing Klebsiella pneumoniae (CPK) for patient care and infection control. The BD MAXTM CRE (automated PCR, Geneohm, Canada) test is the fully automated sample-to-result platform for detection of resistance genes, blaKPC, blaOXA-48 and blaNDM within 2 h. It has been validated for using with colonies and rectal swab. We aimed to evaluate its performance for detection of carbapenemases genes directly from respiratory samples of the patients whom K. pneumoniae (KP) were identified.

    Methods: 169 KP isolates and respiratory samples were collected from patients admitted to King Chulalongkorn Memorial Hospital, Bangkok, Thailand from Jun 2017 to Dec 2017. The automated PCR test was performed directly from respiratory specimens. The results were compared with in-house PCR for detection of carbapenemase genes performed on KP colonies isolated from respiratory specimens as our reference method. Patient and clinical characteristics between patients with CPK and non-CPK were also analyzed.

    Results: The prevalence of CPK was 10.6% (18/169 isolates). The automated PCR test had 91.12% accuracy, 66.7% sensitivity (95% CI, 40.9 to 86.6), 94.0% specificity (95% CI, 88.9 to 86.6), 57.1% positive predictive value (95% CI, 39.5 to 73.1) and 95.9% negative predictive value (95% CI, 92.48 to 97.85). Of 18 isolates, blaOXA-48 was the most common carbapenemase gene (17 isolates; 94.4%), followed by blaNDM-1 (7 isolates; 38.9%). A combination of blaOXA-48 and blaNDM-1 was detected in 6 isolates (33.3%). There were 7 (38.8%) colonizations and 11 (61.1%) infections. The significant risk factors for CPK included post-surgery (p=0.04) and prior antibiotics exposure (p=0.04). There was a trend toward higher mortality in patients with CPK albeit not significantly (33% vs. 24.5%, p=0.41).

    Conclusion: The automated PCR test has an acceptable accuracy with fair sensitivity for the detection of carbapenemase genes. It is unique that OXA-48 and OXA-48/NDM-1 are the most common carbapenemases in our institute. This diagnostic test may be use for rapid diagnosis or infection control purposes. Exposure to antibiotics associated with colonization or infection with CPK. Patients with CPK had higher mortality.

    Preudtipong Noopetch, MD., Department of Medicine, Chulalongkorn University, Bangkok, Thailand, Rongpong Plongla, MD, Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand, Gompol Suwanpimolkul, MD, MSc., Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand and Tanittha Chatsuwan, MD, Chulalongkorn University Division of Microbiology, Department of Medicine, Bangkok, Thailand

    Disclosures:

    P. Noopetch, None

    R. Plongla, None

    G. Suwanpimolkul, None

    T. Chatsuwan, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.