486. Epidemiology of Carbapenem-Resistant Pseudomonas aeruginosa Identified through the Emerging Infections Program (EIP), United States, 2016–2018
Year: 2019
Type: conference-abstract
Abstract: Background Pseudomonas aeruginosa is intrinsically resistant to many commonly used antimicrobials, and carbapenems are often required to treat infections. We describe the crude incidence, epidemiology, and molecular characteristics of carbapenem-resistant P. aeruginosa (CRPA) in the EIP catchment area. Methods From August 1, 2016 through July 31, 2018, we conducted laboratory- and population-based surveillance for CRPA in selected areas in eight sites. We defined a case as the first isolate of P. aeruginosa resistant to imipenem, meropenem, or doripenem from the lower respiratory tract, urine, wounds, or normally sterile sites identified from a resident of the EIP catchment area in a 30-day period. Patient charts were reviewed. Analysis excluded cystic fibrosis patients. A random sample of isolates was collected. Real-time PCR to detect carbapenemase genes and whole-genome sequencing are in progress. Results We identified 4,209 cases in 3373 patients. The annual incidence was 14.50 (95% CI, 14.07–14.94) per 100,000 persons and varied among sites from 4.89 in OR to 25.21 in NY. The median age of patients was 66 years (range: < 1–101), 42.1% were female, and nearly all (97.5%) had an underlying condition. Most cases were identified from urine (42.8%) and lower respiratory tract (35.7%) cultures. Nearly all (93.3%) occurred in patients with inpatient healthcare facility stay, surgery, chronic dialysis, or indwelling devices in the prior year; death occurred in 7.2%. Among 937 isolates tested, 847 (90.4%) underwent PCR; six (0.7%) harbored a carbapenemase, from four sites (CO, MD, NY, and OR): blaVIM (3), blaKPC (2), and blaIMP (1). Of 612 (65.3%) isolates sequenced, the most common ST types were ST235 (9.2%) and ST298 (4.9%). Conclusion Carbapenemases were rarely the cause of carbapenem resistance but were found at EIP sites with high and low CRPA incidence. The emergence of mobile carbapenemases in P. aeruginosa has the potential to increase the incidence of CRPA. Increased detection and early response to carbapenemase-producing CRPA is key to prevent further emergence. Disclosures All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Authors: Julian E Grass, Sandra N Bulens, Wendy M Bamberg, Sarah J Janelle, Kyle Schutz, Jesse T Jacob, Chris W Bower, Rebekah Blakney, Lucy E Wilson, Elisabeth Vaeth, Linda Li, Ruth Lynfield, Paula Snippes Vagnone, Ginette Dobbins, Erin C Phipps, Emily B Hancock, Ghinwa Dumyati, Rebecca Tsay, P Maureen Cassidy, Nicole West, Marion A Kainer, Jacquelyn Mounsey, Richard A Stanton, Gillian A McAllister, Davina Campbell, Joseph D Lutgring, Maria Karlsson, Maroya S Walters
Institutions: Centers for Disease Control and Prevention, Colorado Department of Public Health and Environment, Emory University, University of Maryland, Baltimore County, Maryland Department of Health, Minnesota Department of Health, University of New Mexico, University of Rochester Medicine, Oregon Health Authority, Tennessee Department of Health
Language: English
Subfield: Molecular Medicine
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2897306303