Cargando…
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...
Autores principales: | , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810994/ http://dx.doi.org/10.1093/ofid/ofz360.581 |
_version_ | 1783462371131392000 |
---|---|
author | Jamal, Alainna Coleman, Brenda Johnstone, Jennie Katz, Kevin Muller, Matthew P Patel, Samir Melano, Roberto Rebbapragada, Anu Richardson, David Sarabia, Alicia Mubareka, Samira Poutanen, Susan Zhong, Zoe Kohler, Philipp McGeer, Allison |
author_facet | Jamal, Alainna Coleman, Brenda Johnstone, Jennie Katz, Kevin Muller, Matthew P Patel, Samir Melano, Roberto Rebbapragada, Anu Richardson, David Sarabia, Alicia Mubareka, Samira Poutanen, Susan Zhong, Zoe Kohler, Philipp McGeer, Allison |
author_sort | Jamal, Alainna |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-6810994 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-68109942019-10-28 512. Healthcare-Acquired (HA) Carbapenemase-Producing Enterobacteriales (CPE) in Southern Ontario, Canada: To Whom Are We Transmitting CPE? Jamal, Alainna Coleman, Brenda Johnstone, Jennie Katz, Kevin Muller, Matthew P Patel, Samir Melano, Roberto Rebbapragada, Anu Richardson, David Sarabia, Alicia Mubareka, Samira Poutanen, Susan Zhong, Zoe Kohler, Philipp McGeer, Allison Open Forum Infect Dis Abstracts 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. Oxford University Press 2019-10-23 /pmc/articles/PMC6810994/ http://dx.doi.org/10.1093/ofid/ofz360.581 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Jamal, Alainna Coleman, Brenda Johnstone, Jennie Katz, Kevin Muller, Matthew P Patel, Samir Melano, Roberto Rebbapragada, Anu Richardson, David Sarabia, Alicia Mubareka, Samira Poutanen, Susan Zhong, Zoe Kohler, Philipp McGeer, Allison 512. Healthcare-Acquired (HA) Carbapenemase-Producing Enterobacteriales (CPE) in Southern Ontario, Canada: To Whom Are We Transmitting CPE? |
title | 512. Healthcare-Acquired (HA) Carbapenemase-Producing Enterobacteriales (CPE) in Southern Ontario, Canada: To Whom Are We Transmitting CPE? |
title_full | 512. Healthcare-Acquired (HA) Carbapenemase-Producing Enterobacteriales (CPE) in Southern Ontario, Canada: To Whom Are We Transmitting CPE? |
title_fullStr | 512. Healthcare-Acquired (HA) Carbapenemase-Producing Enterobacteriales (CPE) in Southern Ontario, Canada: To Whom Are We Transmitting CPE? |
title_full_unstemmed | 512. Healthcare-Acquired (HA) Carbapenemase-Producing Enterobacteriales (CPE) in Southern Ontario, Canada: To Whom Are We Transmitting CPE? |
title_short | 512. Healthcare-Acquired (HA) Carbapenemase-Producing Enterobacteriales (CPE) in Southern Ontario, Canada: To Whom Are We Transmitting CPE? |
title_sort | 512. healthcare-acquired (ha) carbapenemase-producing enterobacteriales (cpe) in southern ontario, canada: to whom are we transmitting cpe? |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810994/ http://dx.doi.org/10.1093/ofid/ofz360.581 |
work_keys_str_mv | AT jamalalainna 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe AT colemanbrenda 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe AT johnstonejennie 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe AT katzkevin 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe AT mullermatthewp 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe AT patelsamir 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe AT melanoroberto 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe AT rebbapragadaanu 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe AT richardsondavid 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe AT sarabiaalicia 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe AT mubarekasamira 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe AT poutanensusan 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe AT zhongzoe 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe AT kohlerphilipp 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe AT mcgeerallison 512healthcareacquiredhacarbapenemaseproducingenterobacterialescpeinsouthernontariocanadatowhomarewetransmittingcpe |