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Changing US Epidemiology of NDM-Producing Carbapenem-Resistant Enterobacteriaceae, 2017–2019

Published online by Cambridge University Press:  02 November 2020

Alicia Shugart
Affiliation:
Centers for Disease Control and Prevention
Garrett Mahon
Affiliation:
Centers for Disease Control and Prevention
Lauren Epstein
Affiliation:
Centers for Disease Control and Prevention
Jennifer Y. Huang
Affiliation:
Centers for Disease Control and Prevention
Gillian McAllister
Affiliation:
Centers for Disease Control and Prevention
Adrian Lawsin
Affiliation:
Centers for Disease Control and Prevention
Erisa Sula
Affiliation:
1.) Centers for Disease Control and Prevention and 2.) Oak Ridge Institute for Science and Education (ORISE)
Alison Laufer Halpin
Affiliation:
Centers for Disease Control and Prevention
Amanda Smith
Affiliation:
Ohio Department of Health
Rebekah Carman
Affiliation:
Ohio Department of Health
P. Maureen Cassidy
Affiliation:
Oregon Health Authority
Karim Morey
Affiliation:
Oregon Health Authority
Anu Paranandi
Affiliation:
Connecticut Department of Public Health
Randy Downing
Affiliation:
Connecticut Department of Public Health
Diane Noel
Affiliation:
Connecticut Department of Public Health
Alexander J. Kallen
Affiliation:
Centers for Disease Control and Prevention
Maroya Spalding Walters
Affiliation:
Centers for Disease Control and Prevention
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Abstract

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Background: Due to limited therapeutic options and potential for spread, carbapenem-resistant Enterobacteriaceae (CRE)-producing New Delhi metallo-β-lactamases (NDMs) are a public health priority. We investigated the epidemiology of NDM-producing CRE reported to the CDC to clarify its distribution and relative prevalence. Methods: The CDC’s Antibiotic Resistance Laboratory Network supports molecular testing of CRE for 5 carbapenemases nationally. Although KPC is the most common carbapenemase in the United States, non-KPC carbapenemases are a growing concern. We analyzed CRE with any of 4 non-KPC plasmid-mediated carbapenemases (NDM, VIM, IMP, or OXA-48 type) isolated from specimens collected from January 1, 2017, through June 30, 2019; only a patient’s first isolate per organism–carbapenemase combination was included. We excluded isolates from specimen sources associated with colonization screening (eg, perirectal). We compared the proportion of NDM-producing CRE to all non-KPC–producing CP-CRE between period A (January to June 2018) and period B (January to June 2019). Health departments and the CDC collected additional exposure and molecular information in selected states to better describe current NDM-producing CRE epidemiology. Results: Overall, 47 states reported 1,013 non–KPC-producing CP-CRE (range/state, 1–109 isolates; median, 11 isolates); 46 states reported 631 NDM-producing CRE (range/state, 1–84; median, 6). NDM-producing CRE increased quarterly from the third quarter of 2018 through the second quarter of 2019; CP-CRE isolates with other non-KPC carbapenemases remained stable (Fig. 1). In period A, 124 of 216 emerging CP-CRE had NDM (57.1%), compared with 255 of 359 emerging CP-CRE (71.0%) during period B (P = .1179). Among NDM-producing CRE, the proportion of Enterobacter spp increased from 10.5% in 2018 to 18.4% in 2019 (P = .0467) (Fig. 2). In total, 18 states reported more NDM-producing CRE in the first 6 months of 2019 than in all of 2018. Connecticut, Ohio, and Oregon were among states that conducted detailed investigations; these 3 states identified 24 NDM-producing CRE isolates from 23 patients in period B. Overall, 5 (21.7%) of 22 patients with history available traveled internationally ≤12 months prior to culture; 17 (73.9%) acquired NDM-producing CRE domestically. Among 15 isolates sequenced, 8 (53.3%) carried NDM-5 (6 E. coli, 1 Enterobacter spp and 1 Klebsiella spp) and 7 (46.7%) carried NDM-1 (6 Enterobacter spp and 1 Klebsiella spp). Species were diverse; no single strain type was shared by >2 isolates. Conclusions: Detection of NDM-producing CRE has increased across the AR Lab Network. Among states with detailed information available, domestic acquisition was common, and no single variant or strain predominated. Aggressive public health response and further understanding of current US NDM-CRE epidemiology are needed to prevent further spread.

Disclosures: None

Funding: None

Type
Oral Presentations
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.
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Changing US Epidemiology of NDM-Producing Carbapenem-Resistant Enterobacteriaceae, 2017–2019
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