scholarly journals 1177. Carbapenemase-Producing Carbapenem-Resistant Organism Colonization Screening Surveys, Maryland, April 2017–April 2018

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S355-S355
Author(s):  
Richard B Brooks ◽  
Elisabeth Vaeth ◽  
Niketa M Jani ◽  
Catherine E Dominguez ◽  
Jonathan R Johnston
Keyword(s):  
Resistant Organism ◽  
New Delhi ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Contact Precautions ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Control And Prevention ◽  
Incident Cases

Abstract Background In April 2017, the Maryland Department of Health (MDH) began screening healthcare contacts of confirmed cases of carbapenemase-producing carbapenem-resistant organisms (CP-CROs) to identify potential transmission, per guidance published by the Centers for Disease Control and Prevention. The results of MDH’s CP-CRO colonization screening surveys (CSSs) conducted as of April 1, 2018, are summarized. Methods Rectal swabs were collected on epidemiologically linked CP-CRO contacts and sent to the MDH Laboratories Administration, where the Cepheid Xpert® Carba-R assay was used to detect five carbapenemases: Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-β-lactamase (NDM), Verona integron encoded metallo-β-lactamase (VIM), imipenemase (IMP), and oxacillinase-48-like carbapenemase (OXA-48). Identification of CP-CROs in contacts sometimes resulted in additional CSSs to ensure complete case detection. Non-KPC cases were combined for analysis. Results During April 1, 2017–April 1, 2018, MDH received reports of 278 incident cases of confirmed CP-CROs. Of these, 16 (6%) expressed non-KPC carbapenemases. The 7 (3%) cases with healthcare contacts prompting CSSs led to screening of 132 first-round contacts, with additional CP-CROs identified in 13 (10%), all of which had KPC. Of these, 12 (92%) resided in ventilator units of skilled nursing facilities (vSNFs). In the first-round CSS at one vSNF, 64% of screened contacts were positive for KPC, which had not been identified in the index case. Weekly follow-up CP-CRO admission screenings and serial follow-up CSSs at the vSNF resulted in screening of a total of 72 unique patients; 38 (53%) were KPC-positive. Of these 38 cases, 32 (89%) were previously unidentified and were placed on contact precautions if not already on them. Staff were re-trained in infection prevention (IP) techniques, and staff and KPC-positive patients were cohorted. Conclusion Detection of CP-CROs that express non-KPC carbapenemases in Maryland is rare, and transmission of these carbapenemases has not been identified. However, CSSs identified previously unknown cases of KPC, most commonly in vSNFs, demonstrating the utility of CSSs to detect CP-CROs, and resulting in important IP interventions. Disclosures All authors: No reported disclosures.

scholarly journals 2852. Epidemiology of Emerging Carbapenemase-Producing Organisms (CPO) in Chicago, Illinois, 2013–2018

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S73-S74
Author(s):  
Massimo Pacilli ◽  
Hira Adil ◽  
Kelly Walblay ◽  
Shannon N Xydis ◽  
Whitney Clegg ◽  
...  
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Healthcare Facility ◽  
The United States ◽  
Resistant Organism ◽  
Molecular Testing ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Chicago Area

Abstract Background Emerging CPO in the Chicago area poses clinical and infection control challenges across the spectrum of care. Since November 2013, CPO are reportable to the Illinois’ Extensively Drug-resistant Organism (XDRO) registry. We examined trends in mechanism of resistance (MOR) among CPO reported through December 2018. Methods MOR reported into the XDRO registry were identified by clinical laboratories performing molecular methods on routine clinical cultures, by public health laboratories during point prevalence surveys (PPS) in response to clusters and as part of a project to assess CPO prevalence in high-risk Chicago area healthcare settings. Chicago patients with known MOR other than Klebsiella pneumoniae carbapenemase (KPC) are investigated by Chicago Department of Public Health (CDPH) to implement containment strategies and identify risk factors within 6 months of culture date. Results MOR was identified in 40% (1,216/3,587) of CPO-positive specimens collected from unique Chicago patients; 87% were KPC, 7% New Delhi metallo-β-lactamase (NDM), 5% Verona integron-mediated metallo-β-lactamase (VIM), 0.6% OXA-48-type carbapenemases, and 0.01% Imipenemase metallo-β-lactamase (IMP) (figure). Since 2017, 15 patients with CPO expressed more than one MOR; 14 were identified during PPS at ventilator capable skilled nursing facilities (vSNF) or long-term acute care hospitals (LTACH), and one was hospitalized in India. Among 156 patients with non-KPC CPO, the median age was 64 years (range, 20–97), 107 (69%) were identified from rectal screening and 49 (31%) were from clinical specimens, most of which were urine 23 (47%) or blood 6 (12%). Among 134 patients with risk factor history, 64% had history of tracheostomy (Table 1). Among 113 patients without documented travel outside of the United States, all stayed overnight at an Illinois healthcare facility; 62% stayed in a vSNF and 24% in an LTACH within 6 months of identification (Table 2). Conclusion We have increasingly detected non-KPC CPO in Chicago; however, estimates of prevalence are limited by lack of systematic surveillance and molecular testing. The high proportion of CPO patients without travel who stayed in vSNF or LTACH underscores the need for infection control training and surveillance in these settings. Disclosures All Authors: No reported Disclosures.

scholarly journals Carbapenemase-Producing, Carbapenem-Resistant Acinetobacter baumannii: Summary of CDC Consultations, 2017–2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s151-s152
Author(s):  
Lauren Epstein ◽  
Alicia Shugart ◽  
David Ham ◽  
Snigdha Vallabhaneni ◽  
Richard Brooks ◽  
...  
Keyword(s):  
Public Health ◽  
Acinetobacter Baumannii ◽  
Median Number ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Healthcare Facilities ◽  
Carbapenem Resistant ◽  
Number Of Patients ◽  
Single Facility

Background: Carbapenemase-producing carbapenem-resistant Acinetobacter baumannii (CP-CRAB) are a public health threat due to potential for widespread dissemination and limited treatment options. We describe CDC consultations for CP-CRAB to better understand transmission and identify prevention opportunities. Methods: We defined CP-CRAB as CRAB isolates with a molecular test detecting KPC, NDM, VIM, or IMP carbapenemases or a plasmid-mediated oxacillinase (OXA-23, OXA-24/40, OXA-48, OXA-58, OXA-235/237). We reviewed the CDC database of CP-CRAB consultations with health departments from January 1, 2017, through June 1, 2019. Consultations were grouped into 3 categories: multifacility clusters, single-facility clusters, and single cases. We reviewed the size, setting, environmental culturing results, and identified infection control gaps for each consultation. Results: We identified 29 consultations involving 294 patients across 19 states. Among 9 multifacility clusters, the median number of patients was 12 (range, 2–87) and the median number of facilities was 2 (range, 2–6). Among 9 single-facility clusters, the median number of patients was 5 (range, 2–50). The most common carbapenemase was OXA-23 (Table 1). Moreover, 16 consultations involved short-stay acute-care hospitals, and 6 clusters involved ICUs and/or burn units. Also, 8 consultations involved skilled nursing facilities. Environmental sampling was performed in 3 consultations; CP-CRAB was recovered from surfaces of portable, shared equipment (3 consultations), inside patient rooms (3 consultations) and nursing stations (2 consultations). Lapses in environmental cleaning and interfacility communication were common across consultations. Among 11 consultations for single CP-CRAB cases, contact screening was performed in 7 consultations and no additional CP-CRAB was identified. All 4 patients with NDM-producing CRAB reported recent international travel. Conclusions: Consultations for clusters of oxacillinase-producing CP-CRAB were most often requested in hospitals and skilled nursing facilities. Healthcare facilities and public health authorities should be vigilant for possible spread of CP-CRAB via shared equipment and the potential for CP-CRAB spread to connected healthcare facilities.Funding: NoneDisclosures: None

scholarly journals Evaluation of HiCrome KPC Agar for the Screening of Carbapenem-Resistant Enterobacterales Colonization in the ICU Setting of a Tertiary Care Hospital

2021 ◽  
Author(s):  
Ashoka Mahapatra ◽  
K Nikitha ◽  
Sutapa Rath ◽  
Bijayini Behera ◽  
Kavita Gupta
Keyword(s):  
Tertiary Care ◽  
High Sensitivity ◽  
Care Hospital ◽  
Predictive Values ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Rectal Swabs ◽  
Control And Prevention ◽  
Indian Setting ◽  
Sensitivity Specificity

Abstract Background Spread of carbapenem-resistant Enterobacterales (CRE) is a significant concern in intensive care unit (ICU) settings. Approaches to routine screening for CRE colonization in all ICU patients vary depending on institutional epidemiology and resources. The present study was aimed to evaluate the performance of HiCrome Klebsiella pneumoniae carbapenemase (KPC) agar for the detection of CRE colonization in ICU settings taking the Centers for Disease Control and Prevention (CDC) recommended method as reference. Methods Two-hundred and eighty rectal swabs (duplicate) from 140 patients were subjected to CRE detection in HiCrome KPC agar and MacConkey agar (CDC criteria). Results Using CDC method, total 41 CRE isolates were recovered comprising of 29 E scherichia coli, 11 Klebsiella, and 1 Enterobacter spp. On the other hand, 49 isolates of CRE recovered from 140 rectal swabs using HiCrome KPC agar, out of which 33 were E. coli, 15 Klebsiella, and 1 Enterobacter sp. Statistical Analysis Sensitivity, specificity, negative, and positive predictive values of CRE screening by HiCrome KPC agar were found to be 100% (91.4–100), 91.9% (84.8–95.8), 83.6% (70.9–91.4), and 100% (95.9–100), respectively, taking the CDC recommended method as reference. Conclusion HiCrome KPC agar has high sensitivity in screening CRE colonization. Further studies are needed to establish its applicability for detecting the predominant circulating carbapenemases in the Indian setting.

scholarly journals Neonates with Maternal Colonization of Carbapenemase-Producing, Carbapenem-Resistant Enterobacteriaceae: A Mini-Review and a Suggested Guide for Preventing Neonatal Infection

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 399
Author(s):  
Judy Seesahai ◽  
Paige Terrien Church ◽  
Elizabeth Asztalos ◽  
Melanee Eng-Chong ◽  
Jo Arbus ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Neonatal Infection ◽  
Control Measures ◽  
Resistant Bacteria ◽  
Negative Consequences ◽  
Duration Of Treatment ◽  
Contact Precautions ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (CP-CRE) are highly drug-resistant Gram-negative bacteria. They include New Delhi metallo-ß-lactamase (NDM)-producing carbapenemase (50.4% of all species in Ontario). Antibiotic challenges for resistant bacteria in neonates pose challenges of unknown dosing and side effects. We report two antenatally diagnosed CP-CRE colonization scenarios with the NDM 1 gene. The case involves extreme preterm twins who had worsening respiratory distress at birth requiring ventilator support, with the first twin also having cardiovascular instability. They were screened for CP-CRE, and a polymyxin antibiotic commenced. In the delivery room, neonatal intensive care unit (NICU) and the follow-up clinic, in collaboration with the interdisciplinary group, contact precautions and isolation procedures were instituted. None of the infants exhibited infection with CP-CRE. Consolidating knowledge with regard to CP-CRE and modifying human behavior associated with its spread can mitigate potential negative consequences. This relates to now and later, when travel and prolific human to human contact resumes, from endemic countries, after the current COVID-19 pandemic. Standardized efforts to curb the acquisition of this infection would be judicious given the challenges of treatment and continued emerging antibiotic resistance. Simple infection control measures involving contact precautions, staff education and parental cohorting can be useful and cost-effective in preventing transmission. Attention to NICU specific measures, including screening of at-risk mothers (invitro fertilization conception) and their probands, careful handling of breastmilk, judicious antibiotic choice and duration of treatment, is warranted. What does this study add? CP-CRE is a nosocomial infection with increasing incidence globally, and a serious threat to public health, making it likely that these cases will present with greater frequency to the NICU team. Only a few similar cases have been reported in the neonatal literature. Current published guidelines provide a framework for general hospital management. Still, they are not specific to the NICU experience and the need to manage the parents’ exposure and the infants. This article provides a holistic framework for managing confirmed or suspected cases of CP-CRE from the antenatal care through the NICU and into the follow-up clinic targeted at preventing or containing the spread of CP-CRE.

scholarly journals Predicting Antibiotic Resistance in Urinary Tract Infection Patients with Prior Urine Cultures

2016 ◽  
Vol 60 (8) ◽  
pp. 4717-4721 ◽  
Author(s):  
Yaakov Dickstein ◽  
Yuval Geffen ◽  
Steen Andreassen ◽  
Leonard Leibovici ◽  
Mical Paul
Keyword(s):  
Urinary Tract ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Antibiotic Prescribing ◽  
Content Type ◽  
Extended Spectrum Beta Lactamase ◽  
Carbapenem Resistant ◽  
Positive Urine ◽  
Tract Infections

ABSTRACTTo improve antibiotic prescribing, we sought to establish the probability of a resistant organism in urine culture given a previous resistant culture in a setting endemic for multidrug-resistant (MDR) organisms. We performed a retrospective analysis of inpatients with paired positive urine cultures. We focused on ciprofloxacin-resistant (cipror) Gram-negative bacteria, extended-spectrum-beta-lactamase (ESBL)-producingEnterobacteriaceae, carbapenem-resistantEnterobacteriaceae(CRE), and carbapenem-resistant nonfermenters (CRNF). Comparisons were made between the frequency of each resistance phenotype following a previous culture with the same phenotype and the overall frequency of that phenotype, and odds ratios (ORs) were calculated. We performed a regression to assess the effects of other variables on the likelihood of a repeat resistant culture. A total of 4,409 patients (52.5% women; median age, 70 years) with 19,546 paired positive urine cultures were analyzed. The frequencies of ciprorbacteria, ESBL-producingEnterobacteriaceae, CRE, and CRNF among all cultures were 47.7%, 30.6%, 1.7%, and 2.6%, respectively. ORs for repeated resistance phenotypes were 1.87, 3.19, 48.25, and 19.02 for ciprorbacteria, ESBL-producingEnterobacteriaceae, CRE, and CRNF, respectively (P< 0.001 for all). At 1 month, the frequencies of repeated resistance phenotypes were 77.4%, 66.4%, 57.1%, and 33.3% for ciprorbacteria, ESBL-producingEnterobacteriaceae, CRE, and CRNF, respectively. Increasing time between cultures and the presence of an intervening nonresistant culture significantly reduced the chances of a repeat resistant culture. Associations were statistically significant over the duration of follow-up (60 months) for CRE and for up to 6 months for all other pathogens. Knowledge of microbiology results in the six preceding months may assist with antibiotic stewardship and improve the appropriateness of empirical treatment for urinary tract infections (UTIs).

scholarly journals Decisions to Enter and Leave Skilled Nursing Facilities for Post-Acute Rehabilitation: A Qualitative Study

2020 ◽  
Vol 3 ◽  
Author(s):  
Daniel Chimitt ◽  
Jennifer Carnahan
Keyword(s):  
Older Adults ◽  
Qualitative Study ◽  
Comparative Method ◽  
Skilled Nursing Facilities ◽  
Phone Call ◽  
Healthcare Team ◽  
Discharge Process ◽  
Nursing Facilities ◽  
Skilled Nursing

Background and Hypothesis:   Approximately 40% of patients aged 80+ enter a Skilled Nursing Facility (SNF) following a hospitalization. SNFs can be used as “safety nets” to expedite the discharge process of older adults and it can be difficult to pinpoint how and who made the decision for a hospitalized older adult to discharge to a SNF.   This project examines the factors that drive older adults to enter and leave a SNF for their rehabilitation care.    Project Methods:   Interview transcripts from a qualitative study with patients and their caregivers were used to examine factors influencing admission to and discharge from SNFs. Baseline interviews were conducted within two to seven days after returning home from a SNF stay followed by a follow up phone call one to two weeks after the initial interview. Transcripts and audio files were coded (using NVivo version 12+) for major themes. Interviews were analyzed using a constant comparative method to elicit themes of interest to interviewees.    Results:   There were 24 baseline interviews and X follow up interviews performed with a total of 24 patients and 15 caregivers. The primary theme identified was that patients perceived a loss of autonomy when considering the decision-making process. 75% (18/24) patients or their caregivers felt the healthcare team told them they must go to a SNF for their rehabilitation. 38% (9/24) patients or caregivers felt they had no choice but to leave due to insurance coverage and 50% (12/24) stated that they needed more time.    Potential Impact:   To achieve better patient outcomes, one must understand both the purpose of skilled nursing facilities and also how patients and their families are feeling as they transition through this uncertain period of their lives. Restoring a patient’s sense of autonomy will foster better patient-healthcare relationships and improve trust in the system. 

scholarly journals Longitudinal follow-up study on fear of falling during and after rehabilitation in skilled nursing facilities

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Jan H. M. Visschedijk ◽  
Monique A. A. Caljouw ◽  
Eduard Bakkers ◽  
Romke van Balen ◽  
Wilco P. Achterberg
Keyword(s):  
Fear Of Falling ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Follow Up Study

scholarly journals 82. First 5 Years of Experience with the Illinois Extensively Drug-Resistant Organism (XDRO) Registry and Implementation of Automated Alerting

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S3-S4
Author(s):  
Michael Y Lin ◽  
Angela Tang ◽  
Amy E Fealy ◽  
Wei Gao ◽  
George Markovski ◽  
...  
Keyword(s):  
Syndromic Surveillance ◽  
Resistant Organism ◽  
Candida Auris ◽  
Healthcare Facilities ◽  
Contact Precautions ◽  
Carbapenem Resistant ◽  
Reporting Structure ◽  
Time Of Admission ◽  
Infection Preventionists ◽  
Over Time

Abstract Background The Illinois XDRO Registry was created in November 2013 as an information system for XDROs; currently, the registry includes carbapenem-resistant Enterobacteriaceae (CRE), carbapenemase-producing Pseudomonas aeruginosa, and Candida auris. All Illinois healthcare facilities can manually query the registry at the time of admission to assess patients’ prior colonization status. A subset of facilities, mainly hospitals, participate in the registry’s automated querying process; alerts are generated automatically and sent via email, page, or text to infection preventionists at the time of patient admission. Methods We assessed counts of XDRO report submissions and total queries (manual and automated) over time, by organism. Facilities achieved automated alerts by sending a near-real-time feed of inpatient admission data (patient name and date of birth) to Illinois Department of Public Health (IDPH) via one of the three connection types: direct (data sent directly to IDPH), vendor (data sent via vendor software), and syndromic surveillance (existing syndromic surveillance data adapted for registry). Results In total, 6,445 unique patients (11,258 total reports) from 213 facilities have been reported to the XDRO registry (counts by organism type, Table). The registry has been manually queried 39,678 times by 232 facilities. Seventy-five facilities have achieved automation of alerting; the types of data connections used were direct (N = 56), vendor (N = 18), and syndromic surveillance (N = 1). In total, 5,344 automated alerts have been sent for 1,555 unique patients. Automated alerts per month have increased over time (P < 0.001, Figure). Infection preventionists reported feedback on 3,008 CRE alerts via a website questionnaire; among 1176 first alerts/patient/facility, 49% of patients’ XDRO status were previously unknown to the facility, and 33% were not in contact precautions at the time of alert. Conclusion The XDRO registry, originally focused on CRE, successfully expanded to include emerging XDRO threats such as Candida auris and is poised for rapid response to emerging threats. The registry’s adaptable reporting structure and expanding automation have enabled it to deliver an increasing number of actionable infection-control alerts over time. Disclosures All Authors: No reported Disclosures.

scholarly journals Successful Treatment of Klebsiella pneumoniae Harboring a Klebsiella pneumoniae Carbapenemase Isolated from Lumbar Wound Infection and Blood in a Patient with Hardware Retention

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Alan Bulbin ◽  
Carol Bono ◽  
Tena Philp ◽  
Noriel Mariano ◽  
Carl Urban
Keyword(s):  
Klebsiella Pneumoniae ◽  
Disease Control ◽  
Wound Infection ◽  
Spinal Fusion ◽  
Spinal Stenosis ◽  
Posterior Spinal Fusion ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Control And Prevention ◽  
Carbapenem Resistant Enterobacteriaceae

Infections caused by carbapenem-resistant Enterobacteriaceae, especially carbapenemase producing Klebsiella pneumoniae, represent an urgent threat as outlined by the Centers for Disease Control and Prevention (CDC). We present a 66-year-old male with spinal stenosis who underwent elective L2-pelvis posterior spinal fusion at an outside institution and rapidly developed a complicated infection with Klebsiella pneumoniae harboring Klebsiella pneumoniae carbapenemase. This is the first described case of a patient with Klebsiella pneumoniae harboring Klebsiella pneumoniae carbapenemase causing postoperative lumbar wound infection and bacteremia, successfully treated with ceftazidime-avibactam in combination with additional synergistic antibacterials and without hardware removal.

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