2411. Expanded Susceptibility and Resistance Mechanism Testing Among Carbapenem-Resistant Enterobacteriaceae in Connecticut, 2017. (26th November 2018)

• Record Type: Journal Article
• Authors: Durante, Amanda; Maloney, Meghan; Leung, Vivian; Macierowski, Bobbie; Noel, Diane; Razeq, Jafar; Banach, David
• Is Part Of: Open forum infectious diseases. Volume 5(2018)Supplement 1
• Page Start: S721
• Page End: S721
• Publication Date: 2018-11-26
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy210.2064
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: In Connecticut (CT), submission of clinical carbapenem-resistant Enterobacteriaceae (CRE, resistant to ≥1 carbapenem) isolates to the state public health laboratory (SPHL) was mandated in 2017 for expanded susceptibility and carbapenemase testing. To guide empiric treatment, we created a statewide CRE antibiogram and explored the role of carbapenemase production. Methods: Susceptibility testing was conducted by broth microdilution and disk diffusion and interpreted using Clinical and Laboratory Standards Institute (CLSI) breakpoints, if available. Carbapenemase-producing CRE (CP-CRE) were identified using the modified carbapenem inactivation method (mCIM). Multiplex real-time polymerase chain reaction testing was used to identify genes for common carbapenemases. Results: Of 198 CRE isolates received by the SPHL in 2017, 166 were confirmed as CRE. After patient deduplication, 147 records remained (46.9% Enterobacter, 35.4% Klebsiella, 14.3% Escherichia coli, and 3.4% other). Most were susceptible to ceftazidime/avibactam (CAZ-AVI) (range: 90–100%) and colistin (range 94–100%). Forty-six (31%) were CP-CRE (39 bla KPC, 4 bla NDM, 2 bla OXA-48-like, and 1 gene unknown). Non-CP-CRE were more frequently susceptible ( P <c0.05) than CP-CRE to levofloxacin (67 vs. 26%), moxifloxacin (64 vs. 20%), tigecycline (84 vs. 35%), and tobramycin (84 vs. 35%). Conclusion: CP-CRE have demonstrated significant resistance to noncarbapenem antibiotic classes. Most CRE isolates were susceptible to CAZ-AVI and colistin. The predominant carbapenemase gene is bla KPC . This statewide antibiogram can guide empiric prescribing and formulary selection for CRE treatment. Disclosures: All authors: No reported disclosures.