Los Angeles County Public Health Response to Outbreaks of Carbapenem-Resistant Enterobacteriaceae Associated With Endoscopic Retrograde Cholangiopancreatography

BACKGROUND The incidence of COVID-19 cases and deaths in Skilled Nursing Facilities (SNFs) has garnered tremendous attention across all media. Data verification weaknesses in the reporting systems of public agencies have become magnified by the devastating impact of COVID-19. The result is a COVID-19 infodemic, i.e., “deliberate attempts to disseminate wrong information to undermine the public health response and advance alternative agendas of groups or individuals.” Nonsensical and misleading reports have been submitted to public gatekeepers by Los Angeles County SNFs. The scale of confounding reports suggests intention to mask failure in the management of COVID-19 infections and deaths risk to patients and staff. OBJECTIVE Our aim was to evaluate the extent to which COVID-19 data reported by SNFs has contributed to the COVID-19 infodemic. METHODS This evaluation covered 22 consecutive weeks of SNF data reported to the California Department of Public Health from May 24 through October 24, 2020. We reviewed COVID-19 outcomes reported by 350 Los Angeles County (LAC) SNFs (90.7% of all LAC SNFs). We examined COVID-19 cases and deaths for SNF residents and staff for logical continuity. RESULTS We found illogical reported outcomes for COVID-19 cases and deaths for residents and staff in LAC SNFs. CONCLUSIONS Misleading data misleads regulators and the public regarding the true impact of COVID-19 for SNF residents and staff. We propose the implementation of an integrated reporting model is needed to mitigate inaccuracies and establish a new standard for data verification.

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.502 ◽

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

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1223. Endoscopic Retrograde Cholangiopancreatography (ERCP)-Associated Carbapenem-resistant Enterobacteriaceae (CRE) Before and After Implementation of Ethylene Oxide (ETO) Sterilization of Duodenoscopes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1086 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S439-S440

Author(s):

Kathleen Bonisa ◽

Anupama Neelakanta ◽

Jessica Layell ◽

Jessica Mclain ◽

Haecherl Lana ◽

...

Keyword(s):

Ethylene Oxide ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Tertiary Care ◽

P Value ◽

Endoscopic Retrograde ◽

Carbapenem Resistant ◽

Clinical Culture ◽

High Level ◽

The Impact ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background Reusable duodenoscopes utilized for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures are challenging to clean thoroughly. Outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) have been associated with the use of duodenoscopes even when no clear breaches in manufacturer-recommended manual cleaning and high-level disinfection have been found. We evaluate the impact of implementation of ethylene oxide (ETO) sterilization on rates of ERCP-associated CRE. Methods The charts of all patients who developed CRE colonization or infection between 2012 and 2018 in a large tertiary care teaching hospital were reviewed to determine whether the patient had an ERCP in the 90 days prior to the CRE culture date. Rates of CRE acquisition per 100 ERCPs performed were calculated and compared pre (ERCP performed January 2012 through February 2015) and post-implementation (ERCP performed March 2015 thru December 2018) of routine ETO sterilization of duodenoscope following high-level disinfection (HLD) with an automatic endoscope reprocessor (AER) rather than HLD alone. Results Between 2012 and 2018, 44 patients had first clinical culture with CRE within 90 days of ERCP (36% blood, 34% wound/surgical, 25% urinary and 7% respiratory sources). ETO sterilization of duodenoscopes following manufacturer recommended HLD was implemented March 2015. Rates of first CRE clinical culture within 90 days of ERCP decreased from 0.80 with HLD alone to 0.25 per 100 ERCP procedures with HLD plus ETO (unadjusted IRR 0.31 ETO vs. HLD alone, 95% CI 0.16–0.57, p-value < 0.001). This decrease occurred despite implementation of updated CLSI carbapenem breakpoints in July 2016. Figure 1 shows post ERCP CRE clinical culture trends over time Conclusion Implementation of ETO sterilization for duodenoscopes following HLD reduced our rates of post ERCP CRE in clinical cultures within 90 days of the procedure. Disclosures All authors: No reported disclosures.

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