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      501. Risk of Infection in Persons Colonized with Carbapenemase-Producing Enterobacteriales (CPE) in Ontario, Canada

      , MBBS 1 , , MD-PhD Candidate 2 , , MBBS 1 , , PhD 1 , , MBBS 1 , , MD, FRCPC, PhD 1 , , MD, MSc, FRCPC 3 , , MSc 1 , , MSc, PhD 4 , , MD, FRCPC 5 , , MD, FRCPC, PhD 6 , , PhD, FCCM (D) ABMM 7 , , MSc 1 , , MD, MPH, FRCPC 1 , , PhD, D(ABMM), FCCM, CIC 8 , , MD, FRCPC 9 , , MD, FRCPC 10 , , PhD 1 , , MSc,MD,FRCPC,FSHEA 2

      Open Forum Infectious Diseases

      Oxford University Press

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          Abstract

          Background

          We aimed to assess the risk of subsequent infection among patients colonized by CPE.

          Methods

          The Toronto Invasive Bacterial Diseases Network (TIBDN) has conducted population-based surveillance for CPE colonization/infection in Toronto and Peel region, Ontario, Canada, since CPE were first identified (2007). All laboratories report all CPE isolates to TIBDN. Clinical data are collected via patient interview and hospital chart review. Initially colonized patients are followed for 5y; subsequent CPE infection is defined as an episode with onset >3 days after initial detection of CPE colonization that meets National Healthcare Safety Network criteria for infection with a clinical isolate of CPE.

          Results

          From 2007 to 2018, 790 persons with CPE colonization/infection were identified. Among 364 cases colonized at identification, 42 (12%) subsequently had at least one clinical isolate, and 23 (6%) had an infection: 8 with bacteremia (primary or secondary), 7 UTI, 5 pneumonia, and 3 other. The median time from identification of colonization to infection was 21 days (IQR 7–38), with a probability of developing an infection of 7% at 3 months, and 18% by 3 years (figure). In 305 cases with data available to date, older persons, those admitted to the ICU, and those with current/recent invasive medical devices were more likely to develop infection (table). Gender, underlying conditions and other procedures were not associated with risk of infection. There was a trend to infections being more likely in patients colonized with K. pneumoniae (52% vs. 35%, P = 0.13).

          Conclusion

          The risk of subsequent infection in our cohort was 18%, with highest risk in the first 3 months; most infections occurred in patients requiring intensive care unit admission and invasive medical devices.

          Disclosures

          All authors: No reported disclosures.

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          Author and article information

          Journal
          Open Forum Infect Dis
          Open Forum Infect Dis
          ofid
          Open Forum Infectious Diseases
          Oxford University Press (US )
          2328-8957
          October 2019
          23 October 2019
          23 October 2019
          : 6
          : Suppl 2 , IDWeek 2019 Abstracts
          : S243
          Affiliations
          [1 ] Sinai Health System , Toronto, ON, Canada
          [2 ] University of Toronto , Toronto, ON, Canada
          [3 ] North York General Hospital , Toronto, ON, Canada
          [4 ] Public Health Ontario , Toronto, ON, Canada
          [5 ] Sunnybrook Health Sciences Centre , Toronto, ON, Canada
          [6 ] St. Michael’s Hospital , Toronto, ON, Canada
          [7 ] Public Health Ontario Laboratory , Toronto, ON, Canada
          [8 ] Dynacare , Brampton, ON, Canada
          [9 ] William Osler Health System , Brampton, ON, Canada
          [10 ] Trillium Health Partners , Mississauga, ON, Canada
          Article
          ofz360.570
          10.1093/ofid/ofz360.570
          6811180
          © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

          This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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          Pages: 1
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