bluuebunny/crossref_metadata_2025_split huggingface dataset:
1171. Impact on Mortality, Length of Stay, and Antibiotic Use in Allogenic and Autologous Stem Cell Transplant Patients Colonized With Carbapenemase-Producing Enterobacteriaceae
Authors: Ghani Rohma , Mookerjee Siddharth , Mullish Benjamin , Thursz Mark , Marchesi Julian , Pavlu Jiri , Davies Frances 
Published: November 2018

Abstract

Background
Carbapenemase producing Enterobacteriaceae (CPE) are increasingly impacting on patient management and hospital infection control practice. Stem cell transplant patients are among the most susceptible to invasive infections. Here we explored how this cohort are affected by CPE colonization.

Methods
All patients who underwent an autologous or allograft stem cell transplant (SCT) between September 15 and December 17 at a large tertiary hospital who were CPE positive on routine rectal screening were reviewed. Length of stay (LoS) post SCT, including readmissions for sepsis and number of days of antibiotics therapy, was assessed. Controls were matched for time and type of SCT in a three controls to one case ratio. T-test was performed to analyze differences between groups (statistical significance attributed when P &lt; 0.05).

Results
The case sample had 20 SCT CPE-positive patients, of which allograft (n = 9) and autograft (n = 11). The control sample was made up of 59 SCT CPE-negative patients, allograft (n = 27), and autograft (n = 32). All patients had antibiotic therapy post SCT. Average LoS for the case sample was significantly longer in the autograft group (41.7 vs. 23.6 days, case vs. control, P = 0.01), but not significant in the allograft group (75.1 vs. 58 days, P = 0.12). Both autograft and allograft case samples had significantly longer duration of meropenem therapy, 24.8 vs. 14.4 days for allograft (P = 0.03) and 9.4 vs. 5.5 days for autograft (P = 0.03), cases vs. control. Colistin therapy was longer in both case samples (P = 0.03 in autograft and P = 0.006 in allograft). Tigecycline therapy was significantly longer in the autograft case vs. control sample (P = 0.006), with teicoplanin and piperacillin–tazobactam therapy significantly longer in the autograft case vs. control sample, P = 0.015 and P = 0.03, respectively.

Conclusion
The LoS post SCT and duration of antibiotic therapy were found to be key proxy measures of worsening outcomes for CPE-positive patients vs. CPE-negative patients who had undergone SCT. Although reasons for CPE colonization vary, there appears to be an overall negative impact on patient outcomes and increased use of more toxic agents, demonstrating the need for early directed CPE decontamination therapy of these at-risk patients, such as use of Faecal Microbiota Transplant (FMT).

Disclosures
All authors: No reported disclosures.
1173. A Cluster of Carbapenemase-Producing Acinetobacter baumannii
Authors: Young Heather , Croyle Caroline , Janelle Sarah J , Knepper Bryan , Kurtz Jennifer , Miller Amber , Reese Sara , Schutz Kyle , Bamberg Wendy 
Published: November 2018

Abstract

Background
Carbapenem-resistant A. baumannii (CRAB) is reportable in Colorado with three to 11 cases detected annually. Between December 2017 and February 2018, Denver Health Medical Center (DHMC) detected two inpatients with CRAB in urine. The hospital and the Colorado Department of Public Health and Environment (CDPHE) conducted an investigation to determine epidemiologic links and molecular relatedness of the isolates.

Methods
We reviewed medical records and performed infection control observations among staff. Pulsed-field gel electrophoresis (PFGE) was performed at CDPHE; antimicrobial susceptibility (AST) and carbapenemase testing was performed at CDC.

Results
Epidemiologic investigation: Both patients had neurogenic bladders managed by suprapubic catheters, stage IV decubitus ulcers, and recent surgery. Neither had traveled outside of Colorado. Although both received recent antibiotics, neither received a carbapenem in the 6 previous months. Both isolates were regarded to be asymptomatic bacteriuria. In November 2017, the patients overlapped for 7 days at DHMC on different units. During this week, the same nurse provided wound care for both patients on the same day. Observations of the wound care team revealed opportunities to improve hand hygiene prior to donning and after doffing gloves, the use of single-use scissors on multiple patients, and inconsistent cleaning of a mobile device used to photograph wounds. Microbiologic and molecular investigations: Isolates from the two patients were indistinguishable by PFGE. AST found both isolates susceptible to colistin, but resistant to all other antimicrobials tested (Table 1); both harbored OXA-23-like genes by a Research Use Only assay performed at CDC.

Conclusion
These are the first carbapenemase-producing A. baumannii strains identified in Colorado. We suspect that they were transmitted during the overlapping hospital admission, although we could not determine where the organism originated or the route of transmission. Opportunities to improve hand hygiene and low-level disinfection were identified. The emergence of previously undetected carbapenemases in Colorado is of great public health concern; collaboration between public health and healthcare facilities is critical to halt transmission of novel regional pathogens.

Disclosures
All authors: No reported disclosures.
1174. Epidemiology of Carbapenem-Resistant Enterobacteriaceae, a 5-Year Experience at a Tertiary Care Hospital
Authors: Chotiprasitsakul Darunee , Srichatrapimuk Sirawat , Kirdlarp Suppachok , Santanirand Pitak 
Published: November 2018

Abstract

Background
Carbapenem-resistant Enterobacteriaceae (CRE) has been increasing worldwide. Our objectives were to study the epidemiology of CRE and compare risk factors and mortality of carbapenem nonsusceptibility to ertapenem alone Enterobacteriaceae (NSEE) with nonsusceptibility to other carbapenems (imipenem, meropenem, or doripenem) Enterobacteriaceae (NSOCE) at a tertiary care hospital in Thailand.

Methods
All CRE isolated from clinical and surveillance cultures were identified from December 2011 to December 2016. Quarterly incidence rate per 100,000 patient-days was estimated. Hospital-wide carbapenem consumption were calculated as defined daily doses (DDD) per 1,000 patient-days. Relationships between hospital-wide carbapenem consumption and incidence of CRE were tested using Poisson regression. Comparative analysis of factors associated with NSEE and NSOCE, and risk factors associated with 14- and 30-day mortality in patients with CRE infection was conducted in adult patients.

Results
The quarterly CRE incidence of unique patients increased significantly from 3.37 per 100,000 patient-days in the last quarter of 2011 to 32.49 per 100,000 patient-days in the last quarter of 2016. Quarterly CRE incidence increased 1.07 per 100,000 patient-days (95% confidence interval [CI], 0.49–1.06; P-value for trend &lt;0.001). Quarterly hospital-wide carbapenem consumption increased 1.58 DDD per 1,000 patient-days (95% CI, 0.56–2.59; P-value for trend = 0.004). The expected increase of CRE incidence was 1.02 per 100,000 patient-days for a one DDD per 1,000 patient-days increase in carbapenem consumption (95% CI, 1.01–1.03; P &lt; 0.001). There were 40 patients with NSEE and 134 patients with NSOCE. In the multivariate analysis, lower carbapenem exposure was significantly associated with the NSEE group (adjusted odds ratio: 0.25; 95% CI, 0.11–0.56). No difference in 14-day and 30-day all-cause mortality between NSEE group and NSOCE group was observed.

Conclusion
The incidence of CRE has risen significantly over a 5-year period at our institution. The important risk factor for nonsusceptibility to other carbapenems compared with nonsusceptibility to ertapenem alone was previous carbapenem use. Our hospital-wide carbapenem use has significantly increased over time, and associated with the increasing incidence of CRE.

Disclosures
All authors: No reported disclosures.
1177. Carbapenemase-Producing Carbapenem-Resistant Organism Colonization Screening Surveys, Maryland, April 2017–April 2018
Authors: Brooks Richard B , Vaeth Elisabeth , Jani Niketa M , Dominguez Catherine E , Johnston Jonathan R 
Published: November 2018

Abstract

Background
In April 2017, the Maryland Department of Health (MDH) began screening healthcare contacts of confirmed cases of carbapenemase-producing carbapenem-resistant organisms (CP-CROs) to identify potential transmission, per guidance published by the Centers for Disease Control and Prevention. The results of MDH’s CP-CRO colonization screening surveys (CSSs) conducted as of April 1, 2018, are summarized.

Methods
Rectal swabs were collected on epidemiologically linked CP-CRO contacts and sent to the MDH Laboratories Administration, where the Cepheid Xpert® Carba-R assay was used to detect five carbapenemases: Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-β-lactamase (NDM), Verona integron encoded metallo-β-lactamase (VIM), imipenemase (IMP), and oxacillinase-48-like carbapenemase (OXA-48). Identification of CP-CROs in contacts sometimes resulted in additional CSSs to ensure complete case detection. Non-KPC cases were combined for analysis.

Results
During April 1, 2017–April 1, 2018, MDH received reports of 278 incident cases of confirmed CP-CROs. Of these, 16 (6%) expressed non-KPC carbapenemases. The 7 (3%) cases with healthcare contacts prompting CSSs led to screening of 132 first-round contacts, with additional CP-CROs identified in 13 (10%), all of which had KPC. Of these, 12 (92%) resided in ventilator units of skilled nursing facilities (vSNFs). In the first-round CSS at one vSNF, 64% of screened contacts were positive for KPC, which had not been identified in the index case. Weekly follow-up CP-CRO admission screenings and serial follow-up CSSs at the vSNF resulted in screening of a total of 72 unique patients; 38 (53%) were KPC-positive. Of these 38 cases, 32 (89%) were previously unidentified and were placed on contact precautions if not already on them. Staff were re-trained in infection prevention (IP) techniques, and staff and KPC-positive patients were cohorted.

Conclusion
Detection of CP-CROs that express non-KPC carbapenemases in Maryland is rare, and transmission of these carbapenemases has not been identified. However, CSSs identified previously unknown cases of KPC, most commonly in vSNFs, demonstrating the utility of CSSs to detect CP-CROs, and resulting in important IP interventions.

Disclosures
All authors: No reported disclosures.
1186. Prevalence of Carbapenemase-Producing Enterobacteriaceae (CPE) in Hospital Drains in Southern Ontario
Authors: Jamal Alainna , Baqi Mahin , Borgia Sergio , Cicotelli William , Delibasic Kornelija , Katz Kevin , Johnstone Jennie , Melano Roberto , Muller Matthew , O’Grady Sharon , Patel Samir , Richardson David , Paterson Aimee , Li Angel , McGeer Allison 
Published: November 2018

Abstract

Background
Hospital waste water systems are an emerging reservoir for CPE. We aimed to describe the prevalence of CPE in hospital drains in southern Ontario, where patients are rarely colonized/infected by CPE.

Methods
Ten Ontario hospitals identified rooms occupied by CPE+ inpatients from 2007 to 2017. Drain swabs from patient rooms and communal shower rooms were inoculated into BHI + 10% Dey-Engley neutralizing broth and incubated overnight, then PCR on enriched broth for carbapenemase genes as well as culture on McPOD/McMEM were performed.

Results
Over 10 years in 10 hospitals, 343 CPE+ inpatients exposed 1,205 drains (852 sinks, 353 bathtub/shower drains) in 501 patient rooms and 71 communal shower rooms. 53 (4%) drains in 40 (8%) patient rooms and 10 (14%) communal shower rooms were CPE+ by PCR and culture. CPE+ drains were from 15/475 (3%) hand hygiene sinks, 4/352 (1%) bathroom sinks, 23/272 (9%) bathtubs/showers, and 11/81 (13.6%) communal showers. Eleven (21%) of the CPE+ drains contained 31 CPE gene/species combinations. Patient room drain CPE gene/species combinations are shown in Figure 1: eight (15%) matched the CPE gene/species combination of a room occupant, 23 (43%) matched gene only, and 23 (43%) did not match. 54% of drain isolates were Enterobacter spp. but 9% of patient isolates were Enterobacter spp. There were 155 (13%) additional drains with one or more genes detected by PCR but not culture; 94 (61%) contained VIM (88 bathtub, one bathroom sink, and five hand hygiene sink drains), 33 GES, 17 OXA, 16 IMP, 10 KPC, and five NDM. There were six drains where one or more genes were detected by culture but not PCR; four (67%) were bathtub/shower drains containing an OXA, one bathtub/shower drain containing an NDM, and one hand hygiene sink drain containing a KPC.

Conclusion
Hospital drains may become a reservoir for CPE, which may persist for years. Sensitivity of PCR and culture for detection of CPE and CP organisms may differ. The presence of “unmatched” drains suggests undetected patient colonization. Risk of transmission from drains to room occupants requires investigation.

Disclosures
All authors: No reported disclosures.
1188. Could Chlorehexidine (CHX) Bathing Decrease the Incidence of Carbapenem-Resistant Enterobacteria (CRE) Bacteremia in Previously Colonized CRE Hematopoietic Stem Cell Transplant Recipients (HSCT)?
Authors: Velez Juan Diego , Rosso Fernando , Cedano Jorge , Mora Barbara Lucia , Orrego Marly , Estacio Mayra , Beltran Ivan Andres 
Published: November 2018

Abstract

Background
CRE colonized patients that undergo HSCT have a higher incidence of CRE bacteremia, especially during the initial neutropenic period, with a high mortality rate. This situation is critical in countries highly endemic for CRE such as Colombia. It is necessary to find measures that decrease the occurrence of this infection, permitting a safer transplant. Daily CHX bathing could be effective reducing this risk.

Methods
Since March 2014 in our hospital in Cali, Colombia, all adult patients admitted to the HSCT unit were peri-rectal screened for CRE colonization, and then CHX daily bathing (CHX 4% soap or CHX 2% pads) was used regardless of the screening results. Prospectively all type of microorganism bacteremia were recorded from 2014 to 2017. We compare bacteremia, and CRE bacteremia rates between CRE colonized vs. non-colonized patients. We compared the annual proportion of CRE bacteremia in this two groups. Nonparametrical statistic χ2 for trend was used to compare the difference.

Results
We analyzed data collected from 155 patients from July 2014 to June 2017. There were 39.5% females, and the average age was 42 years, 60% were autologous, and 40% were allogeneic. The total of CRE colonized patients was 25/155 (16%), and the overall of bacteremia was 54/155 (34%). All type of microorganism bacteremia and CRE bacteremia were more frequent in CRE Colonized patients. (52% vs. 31% and 24% vs. 3,8%, RR: 6.24, 95% CI 2.06–18.8, P = 0.002). With the increase in compliance with CHX bathing, there was a decreasing trend in CRE bacteremia in the colonized patient, dropping from 50% during 2014, to 14% in 2017 (OR 0.167; P = 0.21).

Conclusion
Daily CHX bathing in the CRE colonized patient reduce the incidence of CRE bacteremia in HSCT patients. We propose this intervention as a significant protective measure in CRE colonized hospitalized patients.

Disclosures
All authors: No reported disclosures.
1189. A Comprehensive Characterization of the Emerging Carbapenem-Resistant Klebsiella pneumoniae Clinical Isolates From a Public Hospital in Lima, Peru
Authors: Krapp Fiorella , Amaro Catherine , Ocampo Karen , Astocondor Lizeth , Hinostroza Noemi , Riveros Maribel , Garcia Coralith 
Published: November 2018

Abstract

Background
In contrast with other countries in Latin America, Peru had been notoriously spared by the global dissemination of carbapenem-resistant Klebsiella pneumoniae (CR-Kp), until recently. Even though, isolated cases of KPC-producing K. pneumoniae had been reported since 2013, it was not until 2016 that the first outbreak of NDM- producing K. pneumoniae was described in Peru. By 2017, rapid emergence of CR-Kp took place in Hospital Cayetano Heredia (HCH), a tertiary care hospital in Lima. Here, we provide a description of clinical, microbiological and molecular characteristics of CR-Kp isolates recovered at HCH.

Methods
Retrospective review of all CR-Kp clinical isolates recovered at HCH until December 2017. Antibiotic susceptibility data were obtained during routine care (Vitek or disc diffusion) and was assessed using CLSI breakpoints. DNA extraction was performed by heat shock, and PCR was performed to assess carriage of blaNDM gene. String test was performed to detect hypermucoviscosity.

Results
The first case of CR-Kp in HCH dated from July 2015. Since then, a total of 69 CR-Kp clinical isolates, from 60 patients have been recovered until December 2017. A significant increase in the number of cases was observed during 2017 (Figure 1). The average age of patients was 55. Urinary, and respiratory sources of infection or colonization were the most common ones (35% and 30%, respectively), followed by blood stream (17%) and intraabdominal (10%) infections. Isolate recovery and DNA extraction was achieved in 40 cases. Of these, 15 (38%) had a positive PCR for blaNDM carbapenemase gene (Figure 2). Antibiotic susceptibility testing revealed that amikacin was the most effective antimicrobial with the rest of antimicrobials having extremely high rates of resistance (Figure 3). String test was positive in two of these isolates, suggesting that hypervirulent CR-KP might be emerging in this region.

Conclusion
An epidemic of CR-Kp has established in our hospital, representing the first one reported in Peru. The different mechanisms of carbapenem resistance found suggest a polyclonal expansion. Amikacin remains the only active antimicrobial within the routinely tested antibiotics, highlighting the need to add other antimicrobials to the routine panel.

Disclosures
All authors: No reported disclosures.
1191. Prevalence and Microbiology of Carbapenem Resistance Among Six Gram-Negative Pathogens in Bloodstream Infections in US Hospitals, 2010–2015
Authors: Lodise Thomas P , Echols Roger , Wang Weiying , Corvino Frank , Cai Bin 
Published: November 2018

Abstract

Background
Carbapenem resistance (CR) is a growing threat in hospitals in the United States and worldwide. We evaluated the prevalence and geographic distribution of CR among six most common Gram-negative (GN) bloodstream infection (BSI) pathogens in US hospitals.

Methods
We analyzed microbiology data in a cohort of adults (≥18 years) hospitalized in 181 US hospitals contributing microbiology data to the Premier Healthcare Database (October 2010–September 2015) with blood cultures positive for six most common GN pathogens (S. maltophilia assumed 100% CR). We report CR prevalence by pathogen, hospital ward (ICU vs. floor), and census region.

Results
Of the 43,095 GN BSIs included, 1,513 (3.5%) were caused by the six most common CR pathogens (Figure 1). CR was more frequently isolated from patients with an ICU stay (4.7%) vs. those without (2.7%). Nearly 75% (n = 1,100) of CR occurred in nonfermenters (S. maltophilia, P. aeruginosa, and A. baumannii). Among individual organisms, the prevalence of CR—outside of S. maltophilia—was highest among A. baumannii, 35.1%, and lowest among E. coli, 0.2% (Figure 2). Geographically, CR prevalence ranged from highest in the Mountain region (7.1%) to lowest in the West North Central (2.3%) (Figure 3). The maximum CR prevalence occurred in A. baumannii from the East North Central (55.7%), and the minimum in E. coli from the West North Central (0.05%) regions.

Conclusion
Among six most frequently isolated pathogens in BSI, the overall CR prevalence is 3.5%. The wide variations in prevalence based on organism, location in the hospital, and geography emphasize the clinical importance of knowing local pathogen and resistance patterns in order to optimize empiric treatment.

Disclosures
A. F. Shorr, Astellas: Consultant and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium. Cidara: Consultant, Consulting fee. Merck & Co.: Consultant and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium. T. P. Lodise Jr., Motif BioSciences: Board Member, Consulting fee.
1196. Serratia marcescens Strains Carrying blaKPC-2 and blaKPC-3 Carbapenemase Associated With Chronic Mechanical Ventilation
Authors: Fisher Matthew , Diago-Navarro Elizabeth , Kaplun Olga , Sin Eric , Fries Bettina C 
Published: November 2018

Abstract

Background
Carbapenem resistance (CR) in Enterobacteriaceae is a growing concern which the CDC has designated as an urgent threat. At our institution we have noted emergence of CR strains in clinical isolates including a growing number of Serratia marcescens. CR in Serratia marcescens in the United States is mostly reported to be encoded by the SME family of chromosomally encoded carbapenemases, while in Asia it has been described being mediated by transmissible plasmids such as KPC. Here we describe the emergence and characteristics of CR Serratia marcescens at an academic tertiary care hospital in New York.

Methods
Serratia marcescens isolates demonstrating in vitro carbapenem resistance were recovered over a 12-month period from six distinct patients. Antibiotic resistance was determined by standard methods. Real-time PCR for bla(KPC), mcr gene, bla(NDM-1), bla(VIM), and bla(OXA-48) was performed. Patient comorbidities, source of culture, location in the hospital, and co-infection with other CR organisms were investigated.

Results
Fourteen S. marcescens isolates demonstrating in vitro carbapenem resistance were recovered from six individual patients. All six patients had a history of chronic respiratory failure with tracheostomy and at least partial ventilator dependence. Five of the patients were located on the pulmonary intermediate care unit, and one in the pediatric intensive care unit. Twelve of the 14 isolates were tracheal or sputum cultures. Five of the sputum cultures from two patients were co-infected with CR Pseudomonas, and one sputum culture was simultaneously positive for CR Klebsiella pneumoniae and Enterobacter Cloacae. Nine out of 14 isolates were positive for blaKPC-3, two were blaKPC-2 positive, and three were blaKPC-negative, with no mechanism of carbapenem resistance determined yet. None of the other genes were detected.

Conclusion
Most carbapenem-resistant Serratia isolates were derived from respiratory tract and were found to be positive for blaKPC-3. This suggests that plasmid encoded carbapenemases are emerging among Serratia in the United States, which is already being reported in China. Genomic sequencing may establish whether this represents a clonal expansion and whether the blaKPC plasmid was transferred from Klebsiella or Enterobacter to Serratia in one of the patients.

Disclosures
All authors: No reported disclosures.