708. Incidence and Relatedness of Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Infections in Previously Colonized or Infected Patients
Session: Poster Abstract Session: Resistance Mechanisms: Gram-Negative
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • CRE poster.pdf (723.4 kB)
  • Background:

    In patients with history of carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CPCRE), the need for CPCRE targeted treatment in subsequent sepsis episodes is unclear. We determine the likelihood of CPCRE infection (CI) in patients previously colonized (PC) or infected (PI) with CPCRE and relatedness of both episodes.

    Methods:

    Adult inpatients with CPCRE isolated from any site in June 2012 - May 2014 at a tertiary-care hospital were prospectively followed for 2 years to assess for subsequent CI. Bacteria isolates from paired episodes were subjected to Illumina HiSeq2500 and multilocus sequence typing.

    Results:

    Six of 25 (24%) PI and 11 of 152 (7%) PC patients had subsequent CI – overall incidence was 9.6%. KP was most commonly implicated. While bacteria species differed in 4 cases, the carbapenemase type was conserved in all but one. Those with initial bacteremia, intra-abdominal (IA) or lung infection (n=6) were 5 times more likely to develop CI. Only 33% of PI versus 62% of PC patients had subsequent infections of the same clonal group. For PC, KP (OR 9.3) and OXA carbapenemase (OR 12.8) significantly predicted for subsequent CI. In PI, chronic renal failure requiring dialysis (OR 70.2) and KPC enzyme (OR 14) were predisposing factors. In-hospital mortality was observed in 6 cases.

    Initial

    Subsequent

    Time (days)

    Site

    Bacteria

    Gene

    Site

    Bacteria

    Gene

    U

    KP

    OXA-48

    B

    KP

    OXA-48

    26

    IA

    EC

    KPC-2

    L

    KP

    OXA-1; KPC-2

    17

    B

    KP

    KPC-2, ;OXA-1

    B

    KP

    KPC-2; OXA-1

    8

    S

    KP

    OXA-48

    S

    KP

    OXA-48

    146

    L

    KP

    KPC-2

    B

    KP

    KPC-2; OXA-1

    91

    U

    KP

    KPC-2

    S

    KP

    KPC-2

    45

    ECO

    KPC-2

    R

    KP

    OXA-1

    IA

    KP

    OXA-1

    6

    L

    KP

    KPC-2

    B

    KP

    KPC-2

    82

    L

    KP

    OXA-1; KPC-2

    U

    KP

    KPC-2

    23

    R

    ECO

    KPC-2

    IA

    ECO

    KPC

    16

    R

    KP

    NDM-1; OXA-1; OXA-181;

    S

    KP

    NDM-1; OXA-181;

    13

    S

    EC

    OXA-1; OXA-48

    S

    ECO

    OXA-1; OXA-181

    93

    IA

    KP

    KPC-2

    B

    ECO

    OXA-181

    311

    R

    KP

    KPC-2

    U

    KP

    KPC-2; OXA-181

    250

    R

    KP

    KPC-2; OXA-1; OXA-9

    L

    KP

    KPC

    6

    R

    KP

    OXA-1; OXA-181

    B

    ECO

    OXA-181

    5

    R

    KP

    KPC-2; OXA-1

    S

    KP

    KPC

    367

    B: blood; IA: intra-abdominal; L: lung; R: rectal; S: skin soft tissue; U: urine

    EC: Enterobacter cloacae; ECO: Escherichia coli; KP: Klebsiella pneumoniae

    Conclusion:

    Incidence of CI in carriers is low. Patients with IA & respiratory CI in the preceding 93 days are candidates for CPCRE treatment; empiric therapy should be active against the carbapenemase identified in the index episode.

    Sarah Si Lin Tang, BSc (Pharm) (Hons)1, Jocelyn Teo, Masters in Infectious Diseases1, Piotr Chlebicki, MBBS2 and Andrea L. Kwa, PharmD1, (1)Pharmacy, Singapore General Hospital, Singapore, Singapore, (2)Infectious Diseases, Singapore General Hospital, Singapore, Singapore

    Disclosures:

    S. S. L. Tang, None

    J. Teo, None

    P. Chlebicki, None

    A. L. Kwa, 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.