837 - Contamination of Hospital Drains by Carbapenemase-Producing Enterobacterales (CPE) in Ontario, Canada

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Presenting Author(s)

Alainna J. Jamal

Internal Medicine Resident Physician
University of Toronto
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

LM

Laura Mataseje

Biologist
National Microbiology Laboratory, Public Health Agency of Canada
Winnipeg, MB, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KB

Kevin Brown

Scientist
University of Toronto
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KK

Kevin Katz

Head, Microbiology
North York General Hospital
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JJ

Jennie Johnstone

Associate Professor
University of Toronto
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MM

Matthew Muller

Director of Infection Control
Unity Health, University of Toronto
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
VA

Vanessa Allen

Chief Medical Microbiology
Public Health Ontario
Toronto, ON, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SB

Sergio Borgia

Medical Director
William Osler Health System
Brampton, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DB

David Boyd

Biologist
National Microbiology Laboratory, Public Health Agency of Canada
Winnipeg, MB, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
WC

William Ciccotelli

Director of Infection Control
Grand River Hospital
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KD

Kornelija Delibasic

Infection control practitioner
Markham Stouffville Hospital
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
David Fisman

Professor
University of Toronto
Toronto, ON, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Jerome A. Leis

Medical Director, Infection Prevention and Control
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AL

Angel Li

Researcher
Sinai Health System
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MM

Mamta Mehta

Infection Control Practioner
Grand River Hospital
Ktchener, ON, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
WN

Wil Ng

Infection Control Practitioner
North York General Hospital
North York, ON, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RP

Rajni Pantelidis

Professional Practice Leader
William Osler Health Centre
Brampton, ON, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AP

Aimee Paterson

Researcher
Sinai Health System
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GP

Gordana Pikula

Infection control practitioner
Sinai Health System
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RS

Rachel Sawicki

Infection control practitioner
Sinai Health System
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SS

Shelley Schmidt

Infection control practitioner
Grand River Hospital
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RS

Renata Souto

Researcher
Sinai Health System
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LT

Lin Tang

Infection control practitioner
St. Michael's Hospital
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CT

Cameron Thomas

Infection control practitioner
St. Joseph's Health Centre
Toronto, Ontario, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AM

Allison McGeer

Dr.
Mt. Sinai Hospital
Toronto, Ontario, Canada
Disclosure: GlaxoSmithKline (Advisor or Review Panel member, Research Grant or Support)Merck (Advisor or Review Panel member, Research Grant or Support)Pfizer (Research Grant or Support)
MM

Michael Mulvey

Academic Research Microbiologist
National Microbiology Laboratory, Public Health Agency of Canada
Winnipeg, MB, Canada
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: The hospital water environment is a CPE reservoir, and transmission of CPE from drains to patients is a risk.

Methods: We cultured sink and shower drains in patient rooms and communal shower rooms that were exposed to inpatients with CPE colonization/infection from October 2007 to December 2017 at 10 hospitals. We compared patient room drain CPE to prior room occupant CPE using Illumina and MinION whole-genome sequencing.

Results: Three-hundred and ten inpatients exposed 1,209 drains, of which 53 (4%) yielded 62 CPE isolates at 7 (70%) hospitals. Compared to room occupant CPE isolates, drain CPE isolates were more likely Enterobacter spp. (6, 10% vs. 25, 51%, p< 0.0001) or KPC-producers (9, 15% vs. 23, 47%, p=0.0002). Of the 49 CPE isolates in patient room drains, 4 (8%) were linked to a prior room occupant (Table), 24 (49%) had the same carbapenemase as a prior room occupant but isolates/carbapenemase gene-containing plasmids that were unrelated, and 21 (43%) did not share a carbapenemase with a prior room occupant. The 4 drains linked to prior room occupants were likely contaminated by these room occupants, who were CPE-colonized prior to drain exposure. Despite few links between drain and room occupant CPE, there were 10 isolates harbouring related bla_NDM-1-containing IncHI2A/HI2-type plasmids in 8 rooms on two units at one hospital. Nine of these were Enterobacter hormaechei ST66 isolates that were 0 to 6 SNVs apart and one was a Klebsiella oxytoca STnovel isolate.Table. Four patient room drain CPE isolates (D1b, D4, D5, D12) and isolates from prior room occupants that they were related to by whole-genome sequencing.

Conclusion: It was uncommon for drain CPE to be linked to prior patient exposure. This suggests contamination of most drains by undetected colonized patients and a need for more aggressive patient screening in our hospitals. This may also suggest retrograde (drain-to-drain) transmission, especially considering the 10 isolate drain cluster at one hospital. Reasons for the preponderance of Enterobacter spp. in drains requires further study.