2459. Control of a Healthcare–associated Infection Outbreak with Carbapenem-resistant Klebsiella pneumonia at a Respiratory Intensive Care Unit (RICU) in an Acute Care Hospital

BACKGROUND: Carbapenem-resistant Klebsiella pneumonia (CRKP) is among the most serious pathogens of healthcare–associated infections and accounts for significant morbidity and mortality. The study was conducted in a tertiary 1,600-bed hospital where we once reported a suspicious outbreak of ventilator-associated pneumonia caused by Burkholderia cepacia at a surgical intensive care unit (SICU) in 2015. From April 2017, the infection control team (ICT) reported that more cases with positive CRKP cultures from endotracheal aspirate and bronchoalveolar lavage fluid (BALF) were detected than previously in a respiratory intensive care unit (RICU). METHODS: ICT embarked on a field epidemiology investigation immediately to confirm the possibility of a healthcare-associated infection outbreak. The quick reaction to probable outbreak consisted of a serial protocols including contact precaution and antibiotic prescribing to support urgent contain of potential risks. Microbiological investigation was done for patients with epidemiologic traces of any with CRKP infection and colonization in RICU. VITEK 2 compact was used for initial antimicrobial susceptibilities. For those suspected CRE isolates, E-tests were performed as a confirmation for the resistance. The Carbapenem Inactivation Method (CIM) was utilized for detecting the production of carbapenemase. The homology was analyzed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST)． RESULTS: Between April and October in 2017, 13 cases with CRKP infection were identified (Figure 1 and Table 1). Multiple environmental samples of 668 were collected during 7 months. Nearly 75 percent of the involved patients received the first anus swab screening within 48 hours upon RICU admission. The number of the resistance positivity was 26 clinical specimens, 39 anal swabs, and 6 environmental samples. Most of the isolated strain ID and genetic characterization was illustrated as the Figure 2 and 3. CONCLUSION: The origin of the CRKP isolates in RICU probably due to the dissemination of diverse groups. The standardization of the novel and more innovative interventions in tackling such the epidemicity should be implemented further. [Image: see text] [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.