535. Multicenter Study of the Prevalence of Rectal Colonization by Carbapenem-Resistant Enterobacteriaceae in Patients Admitted to the Intensive Care Units of 7 Major Hospitals in Kuwait

BACKGROUND: The emergence of carbapenem-resistant Enterobacteriaceae (CRE) has become an important epidemiological change in infectious diseases in the last 10 years. The gut is an important reservoir for these isolates thereby creating an opportunity for dissemination in a hospital setting especially the intensive care units (ICUs). The objective of this study was to investigate the colonization rates of patients, by CRE, admitted to the ICUs of 7 teaching hospitals. METHODS: Rectal swabs were collected during July 2017 to November 2018 from all patients on the day of ICU admission and 1 week after in each hospital. The samples were screened by direct plating on MacConkey agar containing 10-μg meropenem. Bacterial species identification was performed using the VITEK-2 system. The minimum inhibitory concentrations (MICs) of 14 antibiotics were determined by using Etest. Genes encoding carbapenem resistance was detected by PCR and sequencing. Their clonal relationship was determined by pulsed-field gel electrophoresis (PFGE). RESULTS: A total of 2580 Enterobacteriaceae were isolated from all patients. Seventy-four (2.9%) were confirmed as CRE most of which were from patients in Adan (AH: 36.5%) and Mubarak (MH: 46%) hospitals. Sixty (81.1%) harbored one or more of the tested carbapenemases genes. Forty-six (62.2%) carried bla(OXA-181), 9 (12.2%) bla(OXA-48), one bla(KPC-2), while 14 (18.9%) carried 2 genes. Combinations of bla(KPC-2) and bla(OXA-181) genes were found in 5 (6.8%), bla(VIM-1) and bla(OXA-181) in 4 (5.4%), bla(NDM-5) and bla(OXA-181) in 3 (4.1%) and bla(NDM-1) and bla(OXA-181) in 2 (3.3%). The XbaI PFGE profile-based Dendrogram, at 85% similarity criterion, resolved 7 pulsotypes among isolates carrying bla(OXA-181) in AH and MH designated A, B, C, D, E, F, and G. Further analysis revealed that 7 subpulsotypes A1, A2, A5, A6, C1, C2, and E1 were from unit D in the medical ICU of MH and A3, A4, B1, B3, D1, D2, D3, D4, F1, F2, F3, G1, and G2 were from surgical/medical ICUs in AH. 100% similarity was demonstrated among 8 isolates from AH and 2 from MH. CONCLUSION: The prevalence of rectal colonization by CRE in the ICU patients was lower than expected. Detection of bla(OXA-181) variety and bla(NDM-5) is new to the milieu of genes so far described in isolates from Kuwait. DISCLOSURES: All authors: No reported disclosures.