484. Metallo-β-Lactamase-Positive Carbapenem-Resistant Enterobacteriaceae and Pseudomonas aeruginosa in the Antibiotic Resistance Laboratory Network, 2017–2018

Abstract

BackgroundInfections with metallo-β-lactamase (MBL)-producing organisms are emerging in the United States. Treatment options for these infections are limited. We describe MBL genes among carbapenemase positive carbapenem-resistant Enterobacteriaceae (CP-CRE) and Pseudomonas aeruginosa (CP-CRPA) isolates tested during the first two years of the Antibiotic Resistance Laboratory Network (AR Lab Network).MethodsState and local public health laboratories tested CRE and CRPA isolates for organism identification, antimicrobial susceptibility, and PCR-based detection of blaKPC, blaNDM, blaOXA-48-like, blaVIM, and blaIMP carbapenemase genes. All testing results were sent to CDC at least monthly.ResultsSince January 2017, the AR Lab Network tested 21,733 CRE and 14,141 CRPA. CP-CRE were detected in 37% of CRE; 2% of CRPA were CP-CRPA. Among CP-CRE, 9% (686/8016) were MBL-producers (NDM, VIM, or IMP). Among MBL-producers, a blaNDM gene was detected most often (81%; 551/686). blaNDM were most common among Klebsiella spp. (47%; 261/551), blaIMP were most common among Providencia spp. (53%; 40/75), blaVIM was most common among Enterobacter spp. (19%; 25/62). Twelve percent (96) of MBL CP-CRE contained more than one carbapenemase gene. Among CP-CRPA, 73% (218/300) were MBL producers and blaVIM was the most common gene (62%; 186). Three (1%) MBL CP-CRPA contained more than one carbapenemase.ConclusionIncreased testing of CRE and CRPA isolates through the AR Lab Network has facilitated early and rapid detection of hard-to-treat infections caused by MBL-producing organisms across the United States. The widespread distribution of MBL genes highlights the continued need for containment strategies that help prevent transmission between patients and among healthcare facilities. To support therapeutic decisions for severe infections caused by MBL-producing organisms, the AR Lab Network is now offering rapid susceptibility testing against aztreonam/avibactam, using digital dispenser technology. This testing program aims to close the gap between the availability of new drugs or drug combinations and the availability of commercial AST methods, thereby improving patient safety and antimicrobial stewardship. Disclosures All authors: No reported disclosures.

Carbapenem-Resistant Klebsiella pneumoniae in Large Public Acute-Care Healthcare System, New York, New York, USA, 2016–2022

“…Since its identification in 2001, Klebsiella pneumoniae carbapenemase (KPC) has been the predominant carbapenemase in CRE in medical centers across the United States ( 3 , 4 ). This carbapenemase has been also problematic in long-term care facilities throughout the United States ( 5 , 6 ).…”

“…This carbapenemase has been also problematic in long-term care facilities throughout the United States ( 5 , 6 ). Although isolates with class B carbapenemases, particularly the New Delhi metallo-β-lactamase (NDM), are endemic in several regions of the world, they have been somewhat unusual in the United States, accounting for only ≈10% of identified carbapenemases ( 4 , 7 ). Given their greater resistance to β-lactam antibiotics (e.g., β-lactam/β-lactamase–inhibitor antibiotics, including ceftazidime/avibactam), the spread of isolates harboring metallo-β-lactamases is particularly worrisome ( 8 ).…”

“…

C arbapenems have long served as tools in our arsenal against infections caused by multidrug resistant gram-negative bacteria; as such, the spread of carbapenem-resistant Enterobacterales (CRE) represents a serious public health threat. Because CRE infections are associated with poorer clinical outcomes and have limited treatment options, the Centers for Disease Control and Prevention has labeled CRE as an urgent threat (1,2).Since its identification in 2001, Klebsiella pneumoniae carbapenemase (KPC) has been the predominant carbapenemase in CRE in medical centers across the United States (3,4). This carbapenemase has been also problematic in long-term care facilities throughout the United States (5,6).

…”