1451. Elizabethkingia spp. Outbreak in a Ventilator-capable Skilled Nursing Facility, Chicago 2023

BACKGROUND: In July 2022, the Chicago Department of Public Health (CDPH) was notified of four residents with Elizabethkingia (Ek) infections at a ventilator-capable skilled nursing facility (vSNF A). The facility reviewed microbiology records, identified six additional cases and CDPH initiated an investigation. METHODS: A case-patient was defined as a resident at vSNF A with Ek spp. identified from a clinical specimen. Information was collected via case report form regarding risk factors for Ek infection. Site visits were conducted to observe dialysis, wound care practices, and water disruption. Environmental and clinical isolates were sequenced by the CDC to assess genetic relatedness. RESULTS: January 2021-2023, 14 case-patients were identified with Ek infection: 11 bacteremias, two pneumonias, and one had both. Two case-patients died. Nine case-patients were hemodialyzed, six required ventilator support, and all case-patients had decubitus ulcers. Seven had exposures to tap-water during care. Site visits revealed potential exposure through bathing or healthcare worker hands contaminated by tap-water, personal items on sink-tops, and sterile supplies stored by sinks. Water quality parameters verified chlorine levels above minimum standards by the Illinois Pollution Control Board. Among environmental samples collected, E. anophelis was isolated from first-catch water in the room of a ventilated case-patient. Whole genome sequencing indicated this isolate was closely related to the clinical isolate of the case-patient in the room and a case-patient on a different floor. Both patients were hemodialyzed and exposed to tap-water for bathing. CONCLUSION: Infection control recommendations included avoiding tap-water for bathing, not disposing body-fluid in sinks, routine flushing, disinfecting or removing aerators, and disinfecting sink drains with scheduled foaming disinfectant application. This investigation demonstrates a persistent outbreak of Ek in a vSNF population, likely related to contaminated tap-water. We postulate that Elizabethkingia persisted in water system biofilms, despite measurable chlorine levels, leading to patient exposure by contaminated healthcare worker hands or through tap water bathing in the presence of decubitus ulcers. DISCLOSURES: All Authors: No reported disclosures