1196. Serratia marcescens Strains Carrying bla(KPC-2) and bla(KPC-3) Carbapenemase Associated With Chronic Mechanical Ventilation

BACKGROUND: Carbapenem resistance (CR) in Enterobacteriaceae is a growing concern which the CDC has designated as an urgent threat. At our institution we have noted emergence of CR strains in clinical isolates including a growing number of Serratia marcescens. CR in Serratia marcescens in the United States is mostly reported to be encoded by the SME family of chromosomally encoded carbapenemases, while in Asia it has been described being mediated by transmissible plasmids such as KPC. Here we describe the emergence and characteristics of CR Serratia marcescens at an academic tertiary care hospital in New York. METHODS: Serratia marcescens isolates demonstrating in vitro carbapenem resistance were recovered over a 12-month period from six distinct patients. Antibiotic resistance was determined by standard methods. Real-time PCR for bla(KPC), mcr gene, bla(NDM-1), bla(VIM), and bla(OXA-48) was performed. Patient comorbidities, source of culture, location in the hospital, and co-infection with other CR organisms were investigated. RESULTS: Fourteen S. marcescens isolates demonstrating in vitro carbapenem resistance were recovered from six individual patients. All six patients had a history of chronic respiratory failure with tracheostomy and at least partial ventilator dependence. Five of the patients were located on the pulmonary intermediate care unit, and one in the pediatric intensive care unit. Twelve of the 14 isolates were tracheal or sputum cultures. Five of the sputum cultures from two patients were co-infected with CR Pseudomonas, and one sputum culture was simultaneously positive for CR Klebsiella pneumoniae and Enterobacter Cloacae. Nine out of 14 isolates were positive for bla(KPC-3), two were bla(KPC-2) positive, and three were bla(KPC)-negative, with no mechanism of carbapenem resistance determined yet. None of the other genes were detected. CONCLUSION: Most carbapenem-resistant Serratia isolates were derived from respiratory tract and were found to be positive for bla(KPC-3). This suggests that plasmid encoded carbapenemases are emerging among Serratia in the United States, which is already being reported in China. Genomic sequencing may establish whether this represents a clonal expansion and whether the bla(KPC) plasmid was transferred from Klebsiella or Enterobacter to Serratia in one of the patients. DISCLOSURES: All authors: No reported disclosures.