1186. Prevalence of Carbapenemase-Producing Enterobacteriaceae (CPE) in Hospital Drains in Southern Ontario

BACKGROUND: Hospital waste water systems are an emerging reservoir for CPE. We aimed to describe the prevalence of CPE in hospital drains in southern Ontario, where patients are rarely colonized/infected by CPE. METHODS: Ten Ontario hospitals identified rooms occupied by CPE+ inpatients from 2007 to 2017. Drain swabs from patient rooms and communal shower rooms were inoculated into BHI + 10% Dey-Engley neutralizing broth and incubated overnight, then PCR on enriched broth for carbapenemase genes as well as culture on McPOD/McMEM were performed. RESULTS: Over 10 years in 10 hospitals, 343 CPE+ inpatients exposed 1,205 drains (852 sinks, 353 bathtub/shower drains) in 501 patient rooms and 71 communal shower rooms. 53 (4%) drains in 40 (8%) patient rooms and 10 (14%) communal shower rooms were CPE+ by PCR and culture. CPE+ drains were from 15/475 (3%) hand hygiene sinks, 4/352 (1%) bathroom sinks, 23/272 (9%) bathtubs/showers, and 11/81 (13.6%) communal showers. Eleven (21%) of the CPE+ drains contained 31 CPE gene/species combinations. Patient room drain CPE gene/species combinations are shown in Figure 1: eight (15%) matched the CPE gene/species combination of a room occupant, 23 (43%) matched gene only, and 23 (43%) did not match. 54% of drain isolates were Enterobacter spp. but 9% of patient isolates were Enterobacter spp. There were 155 (13%) additional drains with one or more genes detected by PCR but not culture; 94 (61%) contained VIM (88 bathtub, one bathroom sink, and five hand hygiene sink drains), 33 GES, 17 OXA, 16 IMP, 10 KPC, and five NDM. There were six drains where one or more genes were detected by culture but not PCR; four (67%) were bathtub/shower drains containing an OXA, one bathtub/shower drain containing an NDM, and one hand hygiene sink drain containing a KPC. CONCLUSION: Hospital drains may become a reservoir for CPE, which may persist for years. Sensitivity of PCR and culture for detection of CPE and CP organisms may differ. The presence of “unmatched” drains suggests undetected patient colonization. Risk of transmission from drains to room occupants requires investigation. DISCLOSURES: All authors: No reported disclosures.