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Statewide surveillance of carbapenemase-producing carbapenem-resistant Escherichia coli and Klebsiella species in Washington state, October 2012–December 2017

Published online by Cambridge University Press:  20 March 2020

Mimi R. Precit Open the ORCID record for Mimi R. Precit [Opens in a new window] ,
Kelly Kauber ,
William A. Glover ,
Scott J. Weissman ,
Tashina Robinson ,
Michael Tran  and
Marisa D’Angeli
Mimi R. Precit
Affiliation:
Washington State Public Health Laboratories, Shoreline, Washington
Kelly Kauber
Affiliation:
Washington State Public Health Laboratories, Shoreline, Washington
William A. Glover
Affiliation:
Washington State Public Health Laboratories, Shoreline, Washington
Scott J. Weissman
Affiliation:
Seattle Children’s Research Institute, Seattle, Washington
Tashina Robinson
Affiliation:
Washington State Public Health Laboratories, Shoreline, Washington
Michael Tran
Affiliation:
Washington State Public Health Laboratories, Shoreline, Washington
Marisa D’Angeli*
Affiliation:
Washington State Public Health Laboratories, Shoreline, Washington
*
Author for correspondence: Marisa D’Angeli, E-mail: Marisa.DAngeli@doh.wa.gov
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Abstract

Background:

Carbapenem-resistant Enterobacterales (CRE) are common causes of healthcare-associated infections and are often multidrug resistant with limited therapeutic options. Additionally, CRE can spread within and between healthcare facilities, amplifying potential harms.

Objective:

To better understand the burden, risk factors, and source of acquisition of carbapenemase genes in clinical Escherichia coli and Klebsiella spp isolates from patients in Washington to guide prevention efforts.

Design:

Multicenter prospective surveillance study.

Methods:

Escherichia coli and Klebsiella spp isolates meeting the Washington state CRE surveillance case definition were solicited from clinical laboratories and tested at Washington Public Health Laboratories using polymerase chain reaction (PCR) for the 5 most common carbapenemase genes: blaKPC, blaNDM, blaIMP, blaVIM, and blaOXA-48. Case patients positive by PCR were investigated by the public health department.

Results:

From October 2012 through December 2017, 363 carbapenem-resistant E. coli and Klebsiella spp isolates were tested. Overall, 45 of 115 carbapenem-resistant K. pneumoniae (39%), 1 of 8 K. oxytoca (12.5%), and 28 of 239 carbapenem-resistant E. coli (11.7%) were carbapenemase positive. Of 74 carbapenemase-positive isolates, blaKPC was most common (47%), followed by blaNDM (30%), blaOXA-48 (22%), and blaIMP (1%). Although all cases had healthcare exposure, blaKPC acquisition was associated with US health care, whereas non-blaKPC acquisition was associated with international health care or travel.

Conclusions:

We report that blaKPC, the most prevalent carbapenemase in the United States, accounts for nearly half of carbapenemase cases in Washington state and that most KPC-cases are likely acquired through in-state health care.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 6 , June 2020 , pp. 716 - 722
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

a

Present affiliations: Children’s Hospital of Los Angeles, Los Angeles, California [M.R.P.] and North Carolina State Laboratory of Public Health, Raleigh, North Carolina [W.A.G.].

PREVIOUS PRESENTATION. Some of the data reported here were included in a poster presentation at the Association of Public Health Laboratories 2018 Annual Meeting on June 4 2018, in Pasadena, California and a presentation at the 2018 SHEA Conference on April 19 2018 in Portland, Oregon.

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