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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...

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Autores principales: 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
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
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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.
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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
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