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- Title
507. Epidemiology of Community-Associated Carbapenemase + Producing Carbapenem-Resistant Enterobacteriacae Identified from the Emerging Infections Program, 2012–2017.
- Authors
See, Isaac; Ansari, Uzma; Reses, Hannah; Grass, Julian E; Epson, Erin; Nadle, Joelle; Bamberg, Wendy M; Janelle, Sarah J; Bower, Chris W; Jacob, Jesse T; Vaeth, Elisabeth; Wilson, Lucy E; Lynfield, Ruth; VonBank, Brittany; Vagnone, Paula Snippes; Hancock, Emily B; Phipps, Erin C; Dumyati, Ghinwa; Tsay, Rebecca; Cassidy, Maureen
- Abstract
Background Carbapenemase-producing (CP-) carbapenem-resistant Enterobacteriaceae (CRE) have been almost exclusively linked to extensive healthcare exposure and are of significant concern due to limited treatment options and potential for plasmid-mediated spread of resistance. We report on CP-CRE in community-dwelling individuals. Methods We used 2012–2017 active, laboratory and population-based surveillance data for CRE from CDC's Emerging Infections Program sites (9 sites by 2017). Cases were the first isolation of Escherichia coli , Klebsiella spp. or Enterobacter spp. from a normally sterile body specimen or urine in a surveillance site resident meeting a CRE phenotype (figure) in a 30 day period. Epidemiologic data were obtained from chart review. Cases were community-associated (CA) if not isolated after the first three days of a hospital stay; without inpatient healthcare, dialysis, or surgery in the year prior; and without indwelling medical devices within two days prior to culture. A convenience sample of isolates was tested at CDC by real-time PCR to detect bla KPC, bla NDM, bla OXA-48-like, bla VIM, or bla IMP. Results Of 4023 CRE cases, 699 (17%) were CA, from which 297 isolates were tested; 20 (7%) were CP-CRE, from 18 patients (2 had repeat isolation of the same gene/species). The median age was 68 years (range: 33–91), and 14 (78%) were female. Patients were from 7 sites (range: 1–4/site). Their CP-CRE (10 bla KPC, 6 bla NDM, and 2 bla OXA-48-like) were from three species (10 K. pneumoniae , 6 E. coli , 2 E. cloacae) and isolated from urine (n = 16) and blood (n = 2). Among those with CP-CRE from urine, 12 (75%) had clinical diagnoses of urinary tract infections and the rest had no infection documented. Overall, 7 (39%) were admitted to a hospital within 30 days of culture; none died during hospitalization. Most (n = 13; 72%) had underlying medical comorbidities, most commonly urinary tract abnormalities (n = 5; 28%) and diabetes mellitus (n = 5; 28%). Three (17%) had international travel within two months prior to culture. Conclusion CA CP-CRE were found in most surveillance sites but are rare, occurring primarily in older patients with underlying medical conditions. Patient interviews are planned to determine whether CA CP-CRE may be associated with distant or undocumented healthcare exposures. Disclosures All authors: No reported disclosures.
- Subjects
CENTERS for Disease Control &; Prevention (U.S.); EMERGING infectious diseases; KLEBSIELLA infections; URINARY tract infections; EPIDEMIOLOGY; CARBAPENEMASE; URINARY organs; KLEBSIELLA; KLEBSIELLA pneumoniae
- Publication
Open Forum Infectious Diseases, 2019, Vol 6, pS246
- ISSN
2328-8957
- Publication type
Article
- DOI
10.1093/ofid/ofz360.576