P-1179. Investigations of carbapenemase-producing bacteria among children in U.S. healthcare settings: review of CDC consultations, 2015–2023
Authors: Ali Mohsin , Rankin Danielle A , Prestel Christopher , Walters Maroya S 
Published: January 2025

Abstract

Background
The US Centers for Disease Control and Prevention (CDC) provides technical assistance (consultations) to health departments responding to single cases and clusters of carbapenemase-producing organisms (CPOs). We aimed to characterize consultations involving pediatric patients.Figure 1.Flow diagram of screening of CDC consultations for pediatric CPO cases requiring public health responses or clusters with suspected or confirmed transmission.Abbreviations: AR, antimicrobial resistance; CPO, carbapenemase-producing organism; HAI, healthcare-associated infection.*Includes one additional recent consultation not yet added to database at time of query.†One consultation involved two unrelated single cases and another consultation included 3 subclusters.‡Applicable public-health response components were contact screening, site visit/infection control assessment, and/or environmental sampling.

Methods
We searched CDC databases of healthcare-associated infection (HAI) consultations (November 2001 to January 25, 2024) using pediatric key-word patterns. We reviewed this subset for CPO investigation consultations with at least one pediatric case (age &lt; 18 years with a CPO-positive clinical or screening specimen) or involving a pediatric healthcare facility. We classified CPO consultations as either (a) a cluster with likely transmission or (b) a single case with a public-health response (Figure 1). We abstracted and descriptively analyzed consultation characteristics regarding microbiology, healthcare setting, index patient characteristics, public-health response, and likely transmission mechanisms.Figure 2.Number of CDC consultations for CPOs by year among children in U.S. healthcare settings, 2015–2023.

Results
Among 2338 HAI consultations, 271 (12%) related to pediatric cases or facilities were reviewed (Figure 1). Thirty-three consultations from 2015–2023 across 20 states were included, which comprised 16 single cases and 20 clusters (Figure 2). Eight (40%) clusters only involved pediatric cases and the remainder included both pediatric and adult cases. Most commonly, for 17 (47%) index cases, Enterobacterales was identified in a clinical specimen from an acute-care hospital patient in an intensive care unit (e.g., burn unit; Table 1). The most common carbapenemases were NDM (53%), KPC (28%), and VIM (22%). Among the 16 clusters with available information, the most common transmission mechanisms were gaps in core infection control practices (9, 56%) and premise plumbing (3, 19%). Overall, 9 (56%) single cases and 6 (30%) clusters had history of international healthcare or travel for the index case-patient.Table 1.Microbiologic, healthcare setting, index patient, and public health response characteristics of consultations of CPO among children in U.S. healthcare settings, by consultation type, 2015–2023
Abbreviations: ACH, acute care hospital; CPO, carbapenamase-producing organism; ICU, intensive care unit; IPC, infection prevention and control; LTACH, long-term acute-care hospital; PFGE, pulse field gel electrophoresis; SNF, skilled nursing facility; WGS, whole genome sequencing.
a Proportions may not add to 100% as values may not be mutually exclusive per consultation and/or rounding error.
b Three clusters of VIM–P. aeruginosa in different facilities were part of multistate outbreak linked to artificial tears.
c Denominator for clusters is 16 ACHs. “Other” includes one each of surgery, pediatrics, medicine, and adult ICU units.
d Includes three single cases and one cluster where index case was a US-born patient in a neonatal ICU whose mother had history of international healthcare or travel.
e Includes hand hygiene, Transmission-Based Precautions, and cleaning and disinfection of high-touch surfaces in patient rooms.

Conclusion
Review of CDC consultations for CPOs in pediatric patients identified multiple cases and clusters among high-risk inpatient units. Links to healthcare outside the U.S. were common. Admission screening, particularly on high-risk units, and adherence to core infection control practices may prevent future outbreaks.

Disclosures
All Authors: No reported disclosures