scholarly journals Changing US Epidemiology of NDM-Producing Carbapenem-Resistant Enterobacteriaceae, 2017–2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s25-s26
Author(s):  
Alicia Shugart ◽  
Garrett Mahon ◽  
Lauren Epstein ◽  
Jennifer Y. Huang ◽  
Gillian McAllister ◽  
...  
Keyword(s):  
Public Health ◽  
The United States ◽  
Molecular Testing ◽  
New Delhi ◽  
Public Health Response ◽  
Single Strain ◽  
Carbapenem Resistant ◽  
Relative Prevalence ◽  
State 1 ◽  
Carbapenem Resistant Enterobacteriaceae

Background: Due to limited therapeutic options and potential for spread, carbapenem-resistant Enterobacteriaceae (CRE)-producing New Delhi metallo-β-lactamases (NDMs) are a public health priority. We investigated the epidemiology of NDM-producing CRE reported to the CDC to clarify its distribution and relative prevalence. Methods: The CDC’s Antibiotic Resistance Laboratory Network supports molecular testing of CRE for 5 carbapenemases nationally. Although KPC is the most common carbapenemase in the United States, non-KPC carbapenemases are a growing concern. We analyzed CRE with any of 4 non-KPC plasmid-mediated carbapenemases (NDM, VIM, IMP, or OXA-48 type) isolated from specimens collected from January 1, 2017, through June 30, 2019; only a patient’s first isolate per organism–carbapenemase combination was included. We excluded isolates from specimen sources associated with colonization screening (eg, perirectal). We compared the proportion of NDM-producing CRE to all non-KPC–producing CP-CRE between period A (January to June 2018) and period B (January to June 2019). Health departments and the CDC collected additional exposure and molecular information in selected states to better describe current NDM-producing CRE epidemiology. Results: Overall, 47 states reported 1,013 non–KPC-producing CP-CRE (range/state, 1–109 isolates; median, 11 isolates); 46 states reported 631 NDM-producing CRE (range/state, 1–84; median, 6). NDM-producing CRE increased quarterly from the third quarter of 2018 through the second quarter of 2019; CP-CRE isolates with other non-KPC carbapenemases remained stable (Fig. 1). In period A, 124 of 216 emerging CP-CRE had NDM (57.1%), compared with 255 of 359 emerging CP-CRE (71.0%) during period B (P = .1179). Among NDM-producing CRE, the proportion of Enterobacter spp increased from 10.5% in 2018 to 18.4% in 2019 (P = .0467) (Fig. 2). In total, 18 states reported more NDM-producing CRE in the first 6 months of 2019 than in all of 2018. Connecticut, Ohio, and Oregon were among states that conducted detailed investigations; these 3 states identified 24 NDM-producing CRE isolates from 23 patients in period B. Overall, 5 (21.7%) of 22 patients with history available traveled internationally ≤12 months prior to culture; 17 (73.9%) acquired NDM-producing CRE domestically. Among 15 isolates sequenced, 8 (53.3%) carried NDM-5 (6 E. coli, 1 Enterobacter spp and 1 Klebsiella spp) and 7 (46.7%) carried NDM-1 (6 Enterobacter spp and 1 Klebsiella spp). Species were diverse; no single strain type was shared by >2 isolates. Conclusions: Detection of NDM-producing CRE has increased across the AR Lab Network. Among states with detailed information available, domestic acquisition was common, and no single variant or strain predominated. Aggressive public health response and further understanding of current US NDM-CRE epidemiology are needed to prevent further spread.Disclosures: NoneFunding: None

scholarly journals Carbapenemase Gene Profiles in Carbapenem-Resistant Enterobacteriaceae—United States, January 2018–August 2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s149-s150
Author(s):  
Jennifer Huang ◽  
Amanda Pettinger ◽  
Katie Bantle ◽  
Amelia Bhatnagar ◽  
Sarah Gilbert ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Drug Combination ◽  
The United States ◽  
Molecular Testing ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Gene Profiles ◽  
Carbapenemase Gene ◽  
Carbapenem Resistant Enterobacteriaceae

Background: Carbapenem-resistant Enterobacteriaceae (CRE) cause significant morbidity and mortality each year in the United States. Treatment options for these infections are often limited, in part due to carbapenemases, which are mobile β-lactam-hydrolyzing enzymes that confer multidrug resistance in CRE. As part of the CDC’s Containment Strategy for Emerging Resistance, public health laboratories (PHLs) in the CDC Antibiotic Resistance Laboratory Network (AR Lab Network) have worked to characterize clinical isolates of CRE for rapid identification of carbapenemase genes. These data are then used by public health and healthcare partners to promote patient safety by decreasing the spread of resistance. We summarize carbapenemase gene profiles in CRE, by genus and geography, using data collected through the AR Lab Network from January 2018 through August 2019. Methods: CRE isolates were submitted to 55 PHLs, including those of all 50 states, 4 large cities, and Puerto Rico, in accordance with each jurisdiction’s reporting laws. PHLs performed phenotypic and molecular testing on isolates to detect targeted, emerging carbapenemase genes and reported results to submitters. Carbapenemase-positive (CP) isolates were defined as PCR positive for ≥1 carbapenemase gene tested: blaKPC, blaNDM, blaVIM, blaIMP, blaOXA-48–LIKE. PHLs submitted results to CDC monthly. Genera other than Enterobacter, Klebsiella, and Escherichia coli are categorized as other genera in this analysis. Data were compiled and analyzed using SAS v 9.4 software. Results: From January 2018 to August 2019, the AR Lab Network tested 25,705 CRE isolates; 8,864 of 25,705 CRE (34%) were CP. Klebsiella spp represented the largest proportion of CP-CRE at 68% (n = 6,063), followed by E. coli (12%, n = 1,052), Enterobacter spp (11%, n = 981), and other genera (9%, n = 768). Figure 1a shows the composition of CP-CRE carbapenemase genes by genus. The most common carbapenemase and genus profiles were blaKPC in Klebsiella (74%; 5,562 of 7,561 blaKPC-positive) blaNDM in E. coli (43%; 372 of 868 blaNDM-positive) blaVIM in Enterobacter spp (35%; 25 of 72 blaVIM-positive), and blaIMP among other genera (90%; 92 of 102 blaIMP-positive). Common CP-CRE genes and genera also varied by geography (Fig. 1b). Conclusions: The AR Lab Network has greatly enhanced our nation’s ability to detect and characterize CP-CRE. Our data provide a snapshot of the organisms and regions where mobile carbapenemase genes are most often detected in CRE. Geographic variation in CP gene profiles provides actionable data to inform local priorities for detection and infection control and provide clinicians with situational awareness of the genes and organisms that are circulating in their region.Funding: NoneDisclosures: In this presentation, the authors discuss the drug combination aztreonam-avibactam and acknowledge that this drug combination is not currently FDA-approved.

scholarly journals Investigation and Containment of New Delhi Metallo-β-Lactamase (NDM)–Producing Carbapenem-Resistant Enterobacteriaceae (CRE) in a Hospital Intensive Care Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s305-s305
Author(s):  
Karoline Sperling ◽  
Amy Priddy ◽  
Nila Suntharam ◽  
Adam Karlen
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Outpatient Surgery ◽  
The United States ◽  
Multidrug Resistant ◽  
New Delhi ◽  
Point Prevalence Study ◽  
Carbapenem Resistant ◽  
Multidrug Resistant Organisms ◽  
Carbapenem Resistant Enterobacteriaceae

Background: With increasing medical tourism and international healthcare, emerging multidrug resistant organisms (MDROs) or “superbugs” are becoming more prevalent. These MDROs are unique because they are resistant to antibiotics and can carry special resistance mechanisms. In April 2019, our hospital was notified that a superbug, New Delhi Metallo-β-lactamase(NDM)–producing carbapenem-resistant Enterobacteriaceae (CRE), was identified in a patient who had been transferred to another hospital after being at our hospital for 3 weeks. Our facility had a CRE admission screening protocol in place since 2013, but this patient did not meet the criteria to be screened on admission. Methods: The infection prevention (IP) team consulted with the Minnesota Department of Health (MDH) and gathered stakeholders to discuss containment strategies using the updated 2019 CDC Interim Guidance for Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms (MDROs) to determine whether transmission to other patients had occurred. NDM CRE was classified under tier 2 organisms, meaning those primarily associated with healthcare settings and not commonly identified in the region, and we used this framework to conduct an investigation. A point-prevalence study was done in an intensive care unit that consisted of rectal screening of 7 patients for both CRE and Candida auris, another emerging MDRO. These swabs were sent to the Antibiotic Resistance Laboratory Network (ARLN) Central Regional Lab at MDH for testing. An on-site infection control risk assessment was done by the MDH Infection Control Assessment and Response (ICAR) team. Results: All 7 patients were negative for both CRE and C. auris, and no further screening was done. During the investigation, it was discovered that the patient had had elective ambulatory surgery outside the United States in March 2019. The ICAR team assessment provided overall positive feedback to the nursing unit about isolation procedures, cleaning products, and hand hygiene product accessibility. Opportunities included set-up of soiled utility room and updating our process to the 2019 MDH recommendation to screen patients for CRE and C. auris on admission who have been hospitalized, had outpatient surgery, or hemodialysis outside the United States in the previous year. Conclusions: Point-prevalence study results showed no transmission of CRE and highlighted the importance of standard precautions. This event supports the MDH recommendation to screen for CRE any patients who have been hospitalized, had outpatient surgery, or had hemodialysis outside the United States in the previous year.Funding: NoneDisclosures: None

scholarly journals 1194. Carbapenem-Resistant Enterobacteriaceae in Kentucky: Initial 6 Months of Mechanism Testing

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S361-S361
Author(s):  
Kevin Spicer ◽  
Katelyn Cox ◽  
Rachel Zinner ◽  
Andrea Flinchum
Keyword(s):  
Public Health ◽  
Rural Areas ◽  
Demographic Data ◽  
Acute Care Hospital ◽  
The United States ◽  
Care Hospital ◽  
Local Data ◽  
Carbapenem Resistant ◽  
State And Local ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background A global rise in carbapenem-resistant Enterobacteriaceae (CRE) has been noted over the past two decades. State and local data on CRE are necessary to better inform public health interventions. Methods Reporting of CRE (i.e., Enterobacteriaceae resistant to any carbapenem or shown to produce a carbapenemase) was mandated in Kentucky in 2015. Voluntary submission of isolates to the Antibiotic Resistance Laboratory Network regional laboratory for carbapenemase testing began September 2017. Demographic data collected as part of reporting included age, sex, county of residence, and inpatient/outpatient status. Descriptive and chi-square analyses were performed. Results Between September 1, 2017 and February 28, 2018, 149 CRE were reported to the Kentucky Department for Public Health. Testing for presence of a carbapenemase was performed on 115 isolates (77.2%); 44 (38.3%) were carbapenemase producing (CP)-CRE and Klebsiella pneumoniae carbapenemase (KPC) was identified from 38 (86.4%). Also identified were Verona integron-encoded metallo-β-lactamase (VIM; 5, 11.4%) and New Delhi metallo-β-lactamase (NDM; 1, 2.3%). Identification of carbapenemase varied among genera: Citrobacter (3/4, 75%), Klebsiella (21/40, 52.5%), Serratia (2/5, 40%), Escherichia (6/20, 30%), Enterobacter (11/41, 26.8%), Proteus (0/4, 0%), other genera (1/2, 50%). CRE isolates from urban or suburban areas were more likely CP-CRE than were those from rural areas (30/65, 46.2% vs. 14/50, 28%, P = 0.047). Carbapenemase was identified more often among CRE isolates from currently hospitalized patients than from patients whose cultures were collected outside of an acute care hospital (37/70, 52.8% vs. 7/45, 15.6%; P < 0.001). Conclusion The percentage of CRE that were CP-CRE in Kentucky was comparable with that reported for the United States (38 vs. 32%). Klebsiella spp., the genera historically associated with CP-CRE, made up less than half of CP-CRE. CP isolates were identified from urban, suburban, and rural settings and more frequently from isolates collected in hospitals compared with the community. The additional epidemiology obtained as part of this reporting system has identified metropolitan areas of the state as targets for CRE prevention efforts. Disclosures All authors: No reported disclosures.

Much to Do about Carbapenem-Resistant Enterobacteriaceae: Why Supplementing Surveillance May Be the Key to Stopping Spread

2014 ◽  
Vol 35 (8) ◽  
pp. 984-986 ◽  
Author(s):  
Christopher D. Pfeiffer ◽  
Zintars G. Beldavs
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Artery Bypass ◽  
Vital Signs ◽  
Surgical Site Infections ◽  
Acute Care Hospitals ◽  
Colon Surgery ◽  
The United States ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

(See the article by Thaden et al, on pages 978–983.)It is critical to the future of public health to understand the burden of carbapenem-resistant Enterobacteriaceae (CRE) so that we can effectively target efforts to limit potential spread. The Centers for Disease Control and Prevention (CDC) classifies CRE as 1 of 3 “urgent” antibiotic resistance threats to public health because of the high mortality associated with CRE infection and its rapid dissemination in the United States.What is the current burden of CRE disease? We can glean a snapshot of the national epidemiology of CRE from the CDC’s national surveillance. Rapid geographic spread is evident in the CDC’s national map of CRE, which indicates that all but 3 states now have identified CRE. Incidence by facility type, procedure, device, and organism all have considerable variation, providing preliminary indications where future prevention efforts might best be focused. The 2013 CRE Vital Signs states that 3.9% of short-stay acute care hospitals and 17.8% of long-term acute care hospitals have identified cases of CRE infection among those with catheter-associated urinary tract infection (CAUTI) or central line–associated bloodstream infection (CLABSI). The CDC also reported that 10% of Klebsiella species in intensive care unit (ICU) CLABSIs, ICU CAUTIs, and surgical site infections after colon surgery or coronary artery bypass grafting in 2011 were carbapenem resistant. Although CRE have been reported in most states, it is increasingly clear that wide regional variation exists, from regions of hyperendemicity, such as parts of New York City, to regions apparently free of CRE, such as Maine.

scholarly journals 2462. Public Health Response to Contain the First Outbreak of New Delhi Metallo-β-Lactamase-Producing Klebsiella pneumoniae in Minnesota

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S852-S852
Author(s):  
Brittany VonBank ◽  
Sean O’Malley ◽  
Paula Snippes Vagnone ◽  
Mary Ellen Bennett ◽  
Tammy Hale ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Infection Control ◽  
Care Facility ◽  
The United States ◽  
New Delhi ◽  
Surveillance Culture ◽  
Public Health Response ◽  
Term Care ◽  
Health Response

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) producing the New Delhi-metallo-β-lactamase (NDM) carbapenemase are uncommon in the United States but are a serious threat for untreatable antibiotic-resistant infections. In Minnesota (MN), NDM-CRE is typically associated with receipt of healthcare abroad. We describe the public health response to contain the first outbreak of NDM-CRE in MN. Methods CRE is reportable, with isolate submission to the MN Department of Health (MDH) for MALDI-TOF identification, phenotypic carbapenemase production testing, and PCR for carbapenemase genes. On December 24, 2018, MDH identified a case of NDM-K. pneumoniae in a long-term care facility (LTCF) without travel. MDH initiated an investigation. We defined a case as having NDM-K. pneumoniae matching the outbreak PFGE pattern from a clinical or surveillance culture. Cases were identified through surveillance, point prevalence survey (PPS) rectal swab colonization testing, and PFGE at MDH. MDH collected a healthcare exposure history for all cases. A containment response occurred in any facility where a case received healthcare in the 30 days prior. Results Nine cases of clonal NDM-K. pneumoniae with specimen collection dates between December 24, 2018 and March 26, 2019 were identified; 8 were residents of LTCF A and 1 was a roommate in LTCF B of a former LTCF A resident. PPS testing of 260 healthcare contacts occurred in 6 facilities, including LTCF A, LTCF B, and 4 acute care hospitals (ACH) that accepted LTCF A transfers; 7/9 cases were identified through PPS and 2/9 cases were identified through CRE surveillance. One case from LTCF A was identified in an ACH, but PPS did not identify transmission in ACHs. MDH conducted on-site infection control assessments in 2 LTCFs, identified numerous infection control (IC) lapses at LTCF A, and provided telephone IC consultation to 4 ACHs. Conclusion Surveillance and PPS uncovered an outbreak of NDM CRE in 2 LTCFs. Patient transfers led to a regional public health response lasting several months that included IC consultation and additional PPS. Intervention to coordinate containment responses among interconnected healthcare facilities is critical to containing the spread of novel resistance mechanisms in the United States. Disclosures All authors: No reported disclosures.

scholarly journals Thirty-Day Laboratory-Based Surveillance for Carbapenem-Resistant Enterobacteriaceae in the Minneapolis-St. Paul Metropolitan Area

2014 ◽  
Vol 35 (4) ◽  
pp. 423-425 ◽  
Author(s):  
Edwin C. Pereira ◽  
Kristin M. Shaw ◽  
Paula M. Snippes Vagnone ◽  
Jane E. Harper ◽  
Alexander J. Kallen ◽  
...  
Keyword(s):  
United States ◽  
Metropolitan Area ◽  
The United States ◽  
Carbapenem Resistant ◽  
Over Time ◽  
Carbapenem Resistant Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae (CRE) are a growing problem in the United States. We explored the feasibility of active laboratory-based surveillance of CRE in a metropolitan area not previously considered to be an area of CRE endemicity. We provide a framework to address CRE surveillance and to monitor changes in the incidence of CRE infection over time.

Carbapenem-Resistant Enterobacteriaceae Rectal Screening during an Outbreak of New Delhi Metallo-β-Lactamase–Producing Klebsiella pneumoniae at an Acute Care Hospital

2014 ◽  
Vol 35 (4) ◽  
pp. 434-436 ◽  
Author(s):  
Larissa M. Pisney ◽  
M. A. Barron ◽  
E. Kassner ◽  
D. Havens ◽  
N. E. Madinger
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Teaching Hospital ◽  
Tertiary Care ◽  
Acute Care Hospital ◽  
University Teaching ◽  
New Delhi ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

We describe the results of carbapenem-resistant Enterobacteriaceae (CRE) screening as part of an outbreak investigation of New Delhi metallo-β-lactamase–producing CRE at a tertiary care university teaching hospital. The manual method for CRE screening was useful for detecting patients with asymptomatic CRE carriage but was time-consuming and costly.

(Mis)Information on Digital Platforms: Lessons from Twitter and Sina Weibo in the COVID-19 Pandemic (Preprint)

2021 ◽  
Author(s):  
Sarah Kreps
Keyword(s):  
Public Health ◽  
World Health Organization ◽  
Public Discourse ◽  
The United States ◽  
World Health ◽  
Sina Weibo ◽  
Digital Platforms ◽  
The World ◽  
Health Organization ◽  
Relative Prevalence

BACKGROUND Misinformation about COVID-19 has presented challenges to public health authorities during pandemics. Understanding the prevalence and type of misinformation across contexts offers a way to understand the discourse around COVID-19 while informing potential countermeasures. OBJECTIVE The aim of the study was to study COVID-19 content on two prominent microblogging platform, Twitter, based in the United States, and Sina Weibo, based in China, and compare the content and relative prevalence of misinformation to better understand public discourse of public health issues across social media and cultural contexts. METHODS A total of 3,579,575 posts were scraped from both Weibo and Twitter, focusing on content from January 30th, 2020, when the World Health Organization (WHO) declared COVID-19 a “Public Health Emergency of International Concern” and February 6th, 2020. A 1% random sample of tweets that contained both the English keywords “coronavirus” and “covid-19” and the equivalent Chinese characters was extracted and analyzed based on changes in the frequencies of keywords and hashtags. Misinformation on each platform was compared by manually coding and comparing posts using the World Health Organization fact-check page to adjudicate accuracy of content. RESULTS Both platforms posted about the outbreak and transmission but posts on Sina Weibo were less likely to reference controversial topics such as the World Health Organization and death and more likely to cite themes of resisting, fighting, and cheering against the coronavirus. Misinformation constituted 1.1% of Twitter content and 0.3% of Weibo content. CONCLUSIONS Quantitative and qualitative analysis of content on both platforms points to cross-platform differences in public discourse surrounding the pandemic and informs potential countermeasures for online misinformation.

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