1178. A Multicenter Prospective Study of Clinical and Molecular Epidemiological Analysis of Carbapenem-Resistant Enterobacteriaceae (CRE) and Carbapenemase-Producing Enterobacteriaceae (CPE) in Japan

BACKGROUND: Data of a multicenter study on CRE from Japan are limited. Comparative analyses of carbapenemase-producing Enterobacteriaceae (CPE) and non-carbapenemase-producing CRE (NCP-CRE) have not yet been conducted. METHODS: Cases with CPE or CRE (defined as (1) meropenem [MPM] MIC, ≥2 mg/L or (2) imipenem [IPM] MIC, ≥2 mg/L and cefmetazole MIC, ≥64 mg/L [CLSI criteria]) were included from August 2016 to May 2017. PCR was used to detect carbapenemase. RESULTS: From five tertiary hospitals, 24 isolates (14 CPE and 10 NCP-CRE) were collected from 22 patients. Of the 10 NCP-CRE, seven were Enterobacter aerogenes and three were Enterobacter cloacae; of the 14 CPE, five were Klebsiella pneumoniae; 3, E. cloacae; 3, E. coli; 2, Citrobacter freundii; and 1, E. aerogenes. CPE were frequently isolated from the urine (5 [42%]) and sputum (3 [25%]) and NCP-CRE from sputum (4 [40%]), bile (3 [30%]), and urine (2 [20%]). Cases with CPE were older with more frequent use of urinary catheter and/or NG tube than NCP-CRE (table). The 30-day mortality or length of hospital stay (LOS) did not differ between the two groups. Majority (n = 12) of CPE were identified to carry bla(IMP) (MPM MIC, ≥2 mg/L), and two CPE were positive for bla(OXA-181) and bla(OXA-232) (MPM MIC, ≤1 mg/L). All NCP-CRE had IPM MIC of ≥2 mg/L; 7 (70%) had MPM of ≤1 mg/L. Resistance to amikacin (AMK) and levofloxacin (LFX) was noted in one and five CPE, respectively, whereas all NCP-CRE were sensitive, and nine bla(IMP) and 1 bla(oxa-232) were transferable by conjugation. CONCLUSION: CPE and NCP-CRE had different clinical characteristics. Non-β-lactam treatment options were more available for NCP-CRE than CPE. CPE and NCP-CRE might require different control strategies. DISCLOSURES: All authors: No reported disclosures.