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      512. Healthcare-Acquired (HA) Carbapenemase-Producing Enterobacteriales (CPE) in Southern Ontario, Canada: To Whom Are We Transmitting CPE?

      , MD-PhD Candidate 1 , , PhD 2 , , MD, FRCPC, PhD 2 , , MD, MSc, FRCPC 3 , , MD, FRCPC, PhD 4 , , PhD, FCCM (D), ABMM 5 , , MSc, PhD 6 , , PhD, D(ABMM), FCCM, CIC 7 , , MD, FRCPC 8 , , MD, FRCPC 9 , , MD, FRCPC 10 , , MD, MPH, FRCPC 2 , , PhD 2 , , MD, MSc 11 , , MSc, MD, FRCPC, FSHEA 1

      Open Forum Infectious Diseases

      Oxford University Press

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          Abstract

          Background

          Though CPE in Canada are mainly acquired abroad, outbreaks/transmission in Canadian hospitals have been reported. We determined the incidence of HA CPE in southern Ontario, Canada, to inform prevention and control programs.

          Methods

          Toronto Invasive Bacterial Diseases Network (TIBDN) has performed population-based surveillance for CPE in the Toronto area/Peel region of southern Ontario, Canada, since CPE were first identified in October 2007. Clinical microbiology laboratories report all CPE isolates to TIBDN; annual lab audits are performed. Incidence calculations used first isolates as numerator; denominator (patient-days/fiscal year for Toronto/Peel hospitals) was from the Ontario Ministry of Health and Long-Term Care.

          Results

          The incidence of HA CPE has risen from 0 in 2007/2008 to 0.45 and 0.28 per 100,000 patient-days for all and clinical cases, respectively, in 2017/2018 (Figure, P < 0.0001). 190/790 (24%) incident cases of CPE colonization/infection in southern Ontario from October 2007 to December 2018 were likely HA (hospitalized in Ontario with no history of hospitalization abroad/high-risk travel). Eighty (25%) were female and the median age was 73 years (IQR 57–83 years). 157 (83%) had no prior travel abroad and 33 (17%) had prior low-risk travel. 122 (64%) had their CPE identified >72 hours post-admission (of which 83 also had ≥1 other prior Ontario hospitalization); 68 (36%) had their CPE identified at admission but had recent prior Ontario hospitalization. HA cases vs. foreign acquisitions were significantly more likely K. pneumoniae (48% vs. 38%, P = 0.02) and Enterobacter spp. (20% vs. 7%, P < 0.0001) and less likely E. coli (20% vs. 48%, P < 0.0001). Genes of HA vs. foreign acquisitions were significantly more likely bla KPC (34% vs. 12%, P < 0.0001) and bla VIM (12% vs. 2%, P < 0.0001) and less likely bla NDM±OXA (38% vs. 56%, P < 0.0001) and bla OXA (13% vs. 27%, P = 0.0001). 36 (19%) HA cases had a negative CPE screen before their first positive CPE test (10/36 (28%) were on admission). The median incidence of HA CPE per 100,000 patient-days at each hospital was 0.44 (IQR 0.15–0.68) ( P < 0.0001).

          Conclusion

          A quarter of CPE cases in southern Ontario were HA and the incidence of HA cases is increasing. Most cases were admitted to >1 Ontario hospital. Strategies to control transmission are critical.

          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
          : S247-S248
          Affiliations
          [1 ] University of Toronto , Toronto, ON, Canada
          [2 ] Sinai Health System , Toronto, ON, Canada
          [3 ] North York General Hospital , Toronto, ON, Canada
          [4 ] St. Michael’s Hospital , Toronto, ON, Canada
          [5 ] Public Health Ontario Laboratory , Toronto, ON, Canada
          [6 ] Public Health Ontario Laboratories , Toronto, ON, Canada
          [7 ] Dynacare , Brampton, ON, Canada
          [8 ] William Osler Health System , Brampton, ON, Canada
          [9 ] Trillium Health Partners , Mississauga, ON, Canada
          [10 ] Sunnybrook Health Sciences Centre , Toronto, ON, Canada
          [11 ] Cantonal Hospital of St. Gallen , St. Gallen, Switzerland
          Article
          ofz360.581
          10.1093/ofid/ofz360.581
          6810994
          © 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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