Cargando…
497. Changing Molecular Epidemiology of CRE from 2016–2018, Increase in the Unknown
BACKGROUND: Historically, endemic Klebsiella pneumoniae carbapenemase (KPC) has accounted for the majority of carbapenem-resistant Enterobacteriaceae (CRE) in Los Angeles County (LAC). The LAC Department of Public Health (DPH) initiated enhanced CRE surveillance in 2016 to determine CRE prevalence a...
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/PMC6811140/ http://dx.doi.org/10.1093/ofid/ofz360.566 |
_version_ | 1783462408456503296 |
---|---|
author | Le, Mi Bhaurla, Sandeep OYong, Kelsey McKinnell, James Yang, Yang Manalo, Audrey Ramirez, Julio Hemarajata, Peera Green, Nicole Terashita, Dawn |
author_facet | Le, Mi Bhaurla, Sandeep OYong, Kelsey McKinnell, James Yang, Yang Manalo, Audrey Ramirez, Julio Hemarajata, Peera Green, Nicole Terashita, Dawn |
author_sort | Le, Mi |
collection | PubMed |
description | BACKGROUND: Historically, endemic Klebsiella pneumoniae carbapenemase (KPC) has accounted for the majority of carbapenem-resistant Enterobacteriaceae (CRE) in Los Angeles County (LAC). The LAC Department of Public Health (DPH) initiated enhanced CRE surveillance in 2016 to determine CRE prevalence and track emerging non-KPC resistance mechanisms (IMP, NDM, OXA, and VIM) among CRE to describe characteristics and identify local epidemiology for novel multi-drug-resistant organism (N-MDRO) infection and colonization. METHODS: CRE isolates were voluntarily submitted by local clinical laboratories for mechanism detection by LAC Public Health Laboratory via MALDI-TOF and Nanosphere BC-GN. Baseline isolates were collected in 2016. Results are then presented by year through 2018. For N-MDRO cases, LACDPH interviewed healthcare facility (HCF) staff and cases to obtain case characteristics. Data were analyzed via Microsoft Access and SAS. RESULTS: CRE surveillance isolates were voluntarily submitted by 31 labs representing 34% (34/96) LAC hospitals and 1 large regional lab serving 60% of skilled nursing facilities from January 2016 to December 2018. LACDPH tested 1438 CRE isolates during the study period, 1168 (81%) were carbapenemase producing (CP). The proportion of CP CRE and KPC CRE declined over the study period (Table 1). NDM was the most common non-KPC (n = 30) followed by OXA (n = 28). The proportion of CRE with no genotypic marker increased over the course of the study. Case characteristics were obtained from 41 non-KPC CP CRE cases; median age was 66 years (range: 6–94 years); 12 (29%) expired. Among the 41 cases, 20 (49%) had a central line; 11 (27%) had surgery; 14 (34%) had antibiotics in the 6 months prior to culture date. Of the 41 cases, 11 (27%) had international healthcare exposure within 12 months with an invasive procedure and/or antibiotics. CONCLUSION: Surveillance in a large urban setting suggests the molecular epidemiology of CRE is changing, with declining prevalence of KPC, increasing metallo-β-lactamase CP, and large proportion of isolates without resistance markers detected. Given the worrisome trends in non-KPC CRE, more systematic surveillance is warranted, potentially using more robust molecular epidemiology. [Image: see text] DISCLOSURES: All authors: No reported disclosures. |
format | Online Article Text |
id | pubmed-6811140 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-68111402019-10-29 497. Changing Molecular Epidemiology of CRE from 2016–2018, Increase in the Unknown Le, Mi Bhaurla, Sandeep OYong, Kelsey McKinnell, James Yang, Yang Manalo, Audrey Ramirez, Julio Hemarajata, Peera Green, Nicole Terashita, Dawn Open Forum Infect Dis Abstracts BACKGROUND: Historically, endemic Klebsiella pneumoniae carbapenemase (KPC) has accounted for the majority of carbapenem-resistant Enterobacteriaceae (CRE) in Los Angeles County (LAC). The LAC Department of Public Health (DPH) initiated enhanced CRE surveillance in 2016 to determine CRE prevalence and track emerging non-KPC resistance mechanisms (IMP, NDM, OXA, and VIM) among CRE to describe characteristics and identify local epidemiology for novel multi-drug-resistant organism (N-MDRO) infection and colonization. METHODS: CRE isolates were voluntarily submitted by local clinical laboratories for mechanism detection by LAC Public Health Laboratory via MALDI-TOF and Nanosphere BC-GN. Baseline isolates were collected in 2016. Results are then presented by year through 2018. For N-MDRO cases, LACDPH interviewed healthcare facility (HCF) staff and cases to obtain case characteristics. Data were analyzed via Microsoft Access and SAS. RESULTS: CRE surveillance isolates were voluntarily submitted by 31 labs representing 34% (34/96) LAC hospitals and 1 large regional lab serving 60% of skilled nursing facilities from January 2016 to December 2018. LACDPH tested 1438 CRE isolates during the study period, 1168 (81%) were carbapenemase producing (CP). The proportion of CP CRE and KPC CRE declined over the study period (Table 1). NDM was the most common non-KPC (n = 30) followed by OXA (n = 28). The proportion of CRE with no genotypic marker increased over the course of the study. Case characteristics were obtained from 41 non-KPC CP CRE cases; median age was 66 years (range: 6–94 years); 12 (29%) expired. Among the 41 cases, 20 (49%) had a central line; 11 (27%) had surgery; 14 (34%) had antibiotics in the 6 months prior to culture date. Of the 41 cases, 11 (27%) had international healthcare exposure within 12 months with an invasive procedure and/or antibiotics. CONCLUSION: Surveillance in a large urban setting suggests the molecular epidemiology of CRE is changing, with declining prevalence of KPC, increasing metallo-β-lactamase CP, and large proportion of isolates without resistance markers detected. Given the worrisome trends in non-KPC CRE, more systematic surveillance is warranted, potentially using more robust molecular epidemiology. [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6811140/ http://dx.doi.org/10.1093/ofid/ofz360.566 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 Le, Mi Bhaurla, Sandeep OYong, Kelsey McKinnell, James Yang, Yang Manalo, Audrey Ramirez, Julio Hemarajata, Peera Green, Nicole Terashita, Dawn 497. Changing Molecular Epidemiology of CRE from 2016–2018, Increase in the Unknown |
title | 497. Changing Molecular Epidemiology of CRE from 2016–2018, Increase in the Unknown |
title_full | 497. Changing Molecular Epidemiology of CRE from 2016–2018, Increase in the Unknown |
title_fullStr | 497. Changing Molecular Epidemiology of CRE from 2016–2018, Increase in the Unknown |
title_full_unstemmed | 497. Changing Molecular Epidemiology of CRE from 2016–2018, Increase in the Unknown |
title_short | 497. Changing Molecular Epidemiology of CRE from 2016–2018, Increase in the Unknown |
title_sort | 497. changing molecular epidemiology of cre from 2016–2018, increase in the unknown |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6811140/ http://dx.doi.org/10.1093/ofid/ofz360.566 |
work_keys_str_mv | AT lemi 497changingmolecularepidemiologyofcrefrom20162018increaseintheunknown AT bhaurlasandeep 497changingmolecularepidemiologyofcrefrom20162018increaseintheunknown AT oyongkelsey 497changingmolecularepidemiologyofcrefrom20162018increaseintheunknown AT mckinnelljames 497changingmolecularepidemiologyofcrefrom20162018increaseintheunknown AT yangyang 497changingmolecularepidemiologyofcrefrom20162018increaseintheunknown AT manaloaudrey 497changingmolecularepidemiologyofcrefrom20162018increaseintheunknown AT ramirezjulio 497changingmolecularepidemiologyofcrefrom20162018increaseintheunknown AT hemarajatapeera 497changingmolecularepidemiologyofcrefrom20162018increaseintheunknown AT greennicole 497changingmolecularepidemiologyofcrefrom20162018increaseintheunknown AT terashitadawn 497changingmolecularepidemiologyofcrefrom20162018increaseintheunknown |