512. Healthcare-Acquired (HA) Carbapenemase-Producing Enterobacteriales (CPE) in Southern Ontario, Canada: To Whom Are We Transmitting CPE?

BACKGROUND: Though CPE in Canada are mainly acquired abroad, outbreaks/transmission in Canadian hospitals have been reported. We determined the incidence of HA CPE in southern Ontario, Canada, to inform prevention and control programs. METHODS: Toronto Invasive Bacterial Diseases Network (TIBDN) has performed population-based surveillance for CPE in the Toronto area/Peel region of southern Ontario, Canada, since CPE were first identified in October 2007. Clinical microbiology laboratories report all CPE isolates to TIBDN; annual lab audits are performed. Incidence calculations used first isolates as numerator; denominator (patient-days/fiscal year for Toronto/Peel hospitals) was from the Ontario Ministry of Health and Long-Term Care. RESULTS: The incidence of HA CPE has risen from 0 in 2007/2008 to 0.45 and 0.28 per 100,000 patient-days for all and clinical cases, respectively, in 2017/2018 (Figure, P < 0.0001). 190/790 (24%) incident cases of CPE colonization/infection in southern Ontario from October 2007 to December 2018 were likely HA (hospitalized in Ontario with no history of hospitalization abroad/high-risk travel). Eighty (25%) were female and the median age was 73 years (IQR 57–83 years). 157 (83%) had no prior travel abroad and 33 (17%) had prior low-risk travel. 122 (64%) had their CPE identified >72 hours post-admission (of which 83 also had ≥1 other prior Ontario hospitalization); 68 (36%) had their CPE identified at admission but had recent prior Ontario hospitalization. HA cases vs. foreign acquisitions were significantly more likely K. pneumoniae (48% vs. 38%, P = 0.02) and Enterobacter spp. (20% vs. 7%, P < 0.0001) and less likely E. coli (20% vs. 48%, P < 0.0001). Genes of HA vs. foreign acquisitions were significantly more likely bla(KPC) (34% vs. 12%, P < 0.0001) and bla(VIM) (12% vs. 2%, P < 0.0001) and less likely bla(NDM±OXA) (38% vs. 56%, P < 0.0001) and bla(OXA) (13% vs. 27%, P = 0.0001). 36 (19%) HA cases had a negative CPE screen before their first positive CPE test (10/36 (28%) were on admission). The median incidence of HA CPE per 100,000 patient-days at each hospital was 0.44 (IQR 0.15–0.68) (P < 0.0001). CONCLUSION: A quarter of CPE cases in southern Ontario were HA and the incidence of HA cases is increasing. Most cases were admitted to >1 Ontario hospital. Strategies to control transmission are critical. [Image: see text] DISCLOSURES: All authors: No reported disclosures.